The Coalition submitted a letter to the Senate Health, Labor, and Pensions (HELP) Committee asking that benefit protections for mental health and substance use disorder treatment and recovery support services through the exchanges and individual/small group markets be maintained and that those benefits be offered consistent with the Mental Health Parity and Addiction Equity Act (MHPAEA) as the committee works to develop a market stabilization framework.
The letter expresses serious concerns about proposals to loosen the Affordable Care Act’s (ACA) Section 1332 waiver requirements and thereby allow states to waive key consumer protections such as the Essential Health Benefit (EHB) requirements. If states are allowed to modify benefit design and/or allow flexibility between EHB categories, the letter outlines recommendations including requesting that the legislation state explicitly that a comprehensive addiction and mental health treatment benefit must be maintained and compliant with MHPAEA.
Prior to the ACA, 34% of enrollees in the individual market did not have coverage for substance use disorder treatment, and 18% did not have coverage for mental health services. Moreover, the Congressional Budget Office (CBO) confirmed in its May 2017 report on the American Health Care Act that these services are most likely to be excluded. CBO states, “Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits. In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services.”