The city of Colorado Springs, CO is no stranger to the issues of mental health and addiction. With a system-wide inability to provide simultaneous treatment for both, it is up to the service agencies in the city to proactively address the various causes of poverty and homelessness. From mental health care to substance abuse programs, to housing opportunities and medical care, there are many ways to make a difference. The limits on insurance benefits for mental health services date back to the 1950s when private insurers had few incentives to cover services already paid for through the public sector.
Despite the fact that the proportion of private companies that include mental health and substance abuse coverage in their benefit packages has increased significantly over the past three decades, the U. S. National Compensation Survey indicates that limits on days and visits have become stricter over time. In 1995, Senator Domenici partnered with Senator Paul Wellstone (D-MN) to introduce a relatively comprehensive parity bill (S.
29) and tried to attach it to the Health Insurance Portability and Accountability Act (HIPAA). The Congressional Budget Office (CBO) published an estimate that the bill would impose direct costs on the private sector of 4 percent of private health insurance premiums. In April 1996, the Senate approved parity by 68 votes in favor and 30 against as an amendment to HIPAA legislation, but this provision was withdrawn during conference negotiations between the House of Representatives and the Senate. The Employee Retirement Income Security Act (ERISA) of 1974 limits the scope of all state parity laws by exempting companies that self-insure from state insurance mandates. The Kaiser Family Foundation estimated that between 33 and 50 percent of U.
employees had self-insured plans in 2000 and therefore, according to ERISA, would not be covered by state parity laws. Using the insurance component of the Medical Expenses Panel (MEPS-IC) survey, Buchmueller and colleagues estimated that, although 45 percent of all insured private sector employees lived in a state with a strong parity law, the ERISA exemption halved the number of employees actually covered by state parity laws. In 2002, President George W. Bush publicly stated his support for more equivalent mental health coverage when he announced the formation of the President's New Freedom Mental Health Commission. This event recorded that a Republican president supported parity, along with a powerful Republican leader in Congress, thus describing parity as a bipartisan political aspiration. The National Institute of Mental Health (NIMH) was instrumental in making the initial investment in the development and dissemination of research results on expanding mental health benefits.
The NIMH National Mental Health Advisory Council (NAMHC) prepared reports summarizing the current knowledge base on parity in managed care and delivered them to Congress. Actuarial firms hired by groups representing the business community and the insurance industry did not usually consider the effects of managed care when estimating expected changes in total premiums due to parity. These estimates ranged up to a 12 percent increase in total premiums. Colorado Springs is taking steps towards addressing issues of mental health and addiction through various service agencies that are actively working towards providing better access to care for those who need it most. With initiatives such as parity laws being implemented at both state and federal levels, there is hope for a brighter future for those affected by these issues.
