NonDiscrimination in Health Insurance

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Non-Discrimination in Health Insurance

• Ken Roy, MD
• Addiction Recovery Resources of New Orleans
• River Oaks Hospital
• Tulane Department of Psychiatry
• kenroymd_at_cox.net

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Parity Is The Solution

• Entitled Non-Discrimination
• The best and most humane and most effective way
  to actualize a market based solution to a social,
  economic and values-based problem
• Private sector solution

3
JoinTogether.org

• Recommendations from a National Policy Panel
• ENDING DISCRIMINATION
• AGAINST PEOPLE WITH
• ALCOHOL AND DRUG PROBLEMS
• 2003

4
What Has Happened

• Business and Insurance have abdicated treatment
  to the State
• 80 of treatment in some states is in the state
  system
• Less than 20 of people who ask for treatment
  actually receive it

5
Who Is Affected

• Working people
• Family members of workers
• Tax payers
• Home owners

6
Why Is Parity Needed

• 60 to 80 of workers medically indigent for
  substance abuse services
• Huge cost to business, industry and the
  healthcare delivery system

7
EnsuringSolutions.org

• Problem drinking exacts a 9.2 billion toll on
  state budgets each year greater than the costs
  of either illicit drugs or tobacco.
• Studies in 11 states show that this high fiscal
  burden can be substantially reduced by bringing
  private insurance coverage for alcohol problems
  inline with coverage for other illnesses.
• Although 80 percent of people who have alcohol
  use disorders work, and most individuals who seek
  treatment for addiction have health insurance
  through their employers, their health plans cover
  treatment for only a few.

8
EnsuringSolutions.org

• Parity health insurance that provides coverage
  of treatment for mental illnesses and substance
  abuse equal to coverage for other illnesses
  could enable many more people to recover from
  their alcohol problems while resulting in
  significant savings to states and businesses.
• An extensive Ensuring Solutions analysis of 11
  state studies on parity shows that its cost to
  insurers is negligible raising annual premiums
  just 0.2 percent.

9
EnsuringSolutions.org

• The cost of parity is comparatively small when
  compared to overall health expenditures and when
  spread out over all enrolled members, concluded
  Californias State Legislative Analysts Office
  after reviewing health insurance coverage of
  substance abuse treatment.
• Mandating parity would not place an undue burden
  on businesses that offer health insurance to
  their employees.

10
EnsuringSolutions.org

• The analysis shows that
• Equitable coverage reduces pressures on
  financially distressed states budgets (and the
  tax burden to states citizens and businesses).
• Oregon, for example, found the state saves 5.62
  in tax-supported health, corrections and welfare
  costs for every state dollar spent
• Parity increases the number of people who receive
  treatment, thereby reducing their long-term cost
  to the state. In addition, more get treatment as
  outpatients and inpatients, while the length of
  (more expensive) hospital stays is sharply
  reduced.

11
EnsuringSolutions.org

• A North Carolina legislative report concludes
• Studies from several states have consistently
  shown that appropriate treatment of chemical
  dependency results in a significant reduction in
  medical claims, absenteeism, and disability an
  increase in productivity and a healthier and
  safer environment for all employees.
• According to a PricewaterhouseCoopers actuarial
  analysis, the cost of parity to individual
  businesses goes down sharply when all or most
  businesses in a state are required to have equal
  coverage.

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Why Parity Is Right

• Chronic disease
• Primary disease
• Relapsing disease
• Medical model

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What Has Been Done Legislatively

• 7 states have comprehensive parity legislation
  for addiction (CT, DE, ME, MN, VT, VA, WV.)
• 2 more have parity for state employees (NC, SC.)
• 12 or more states will file in their next
  sessions
• 15 - 20 of the country could be covered in the
  next 2 years

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Federal Efforts

• HEART Act H 2256 S 1138
• Senate legislation is pending from Sen. Coleman
  (D-MN) for Mental Health
• House legislation is pending from rep. Roukema
  (R-NJ) rep. Ramstad (R-MN)
• Federal employees have mandated coverage since
  2001