The Mental Health Association in Michigan

is the only statewide, non-governmental agency concerned with the broad spectrum of mental illness across all age groups.

August 17, 2012

Parity Testimony, Mark Reinstein, to the Hon. Patrick Kennedy, 4-26-12, Kalamazoo

Testimony of Mark Reinstein

Mental Health Association in Michigan & Michigan Partners for Parity

Mental Health Parity Forum – April 26, 2012 – Kalamazoo

To the Honorable Patrick Kennedy and Participants in the April 26 Forum,


I’m Mark Reinstein, President & CEO of the Mental Health Association in Michigan, our state’s oldest advocacy organization for persons experiencing mental illness. I’m also on the steering committee of Michigan Partners for Parity, a statewide coalition with more than 60 members that seeks the enactment of mental health parity law in Michigan.


I appreciate the opportunity to make comment today on the parity situation here in Michigan and nationally.


We are grateful for the work that Congress did on the 2008 federal parity law because it is the only way privately insured in Michigan can get coverage equality for mental health. Michigan is one of just seven states without its own parity law. Thus, implementation of the federal law is certainly of significant interest here, and I’ll comment on that shortly.


First, I want to review our own state situation.


Even with full and effective implementation of the federal law, there would still be over 1.5 million otherwise privately insured state residents without equal coverage in their policies for mental health and substance abuse. The federal parity law doesn’t apply to employers with less than 51 employees or to individual policies. We know that this gap could be cut down in 2014 with the advent of health insurances exchanges and other steps under the Affordable Care Act. But that act is under threat right now; it may not survive the Supreme Court in sum or in part; and what will happen to persons who would benefit from it is a source of consternation. I believe you’ll hear from one of those persons later today.


The bottom line right now is that Michigan still needs its own parity law to supplement the 2008 national law. Michigan Partners for Parity has been trying to stimulate a state law for over 15 years. We have not been able to break through against opposition from the business community, which was a common barrier in all the states that did parity laws, or opposition from the UAW, something that we believe is unique to Michigan and, more than any other factor, has held us back.


We have been told countless times by legislators that they are opposed to health insurances “mandates” regarding workplace coverage, and that the cost of parity would be too great. Yet the legislation we have advanced is not a mandate – employers would decide whether to include mental health coverage just as with the federal law – and it has been universally documented in the research literature that parity costs virtually nothing while saving money in numerous areas.


Given what we’ve heard so often from legislators over the years, it was a source of puzzlement to many when the Michigan Legislature recently decided to adopt an absolute mandate for coverage of autism spectrum disorders; to include in that mandate a specifically named treatment that can cost up to $50,000 annually; and to commit an

as-yet unknown amount of multiple millions in annual taxpayer dollars to support this effort. All the while, the Legislature turned its back on our non-mandate approach that won’t cost taxpayers a cent.


So we are totally dependent on the federal parity law for help here. If fully and effectively implemented, it could bring mental health protection to over 3.5 million privately insured in Michigan. Unfortunately, we don’t see signs of full and effective implementation yet.


It has been over three years since enactment, but there are still no final administrative rules for the law. The interim regulations released to date have huge gaps making the law difficult to operationalize and enforce. Former Senator Domenici wrote very recently that governmental data show “levels of care for evidence-based behavioral treatments, such as residential psychiatric services for children, are being eliminated because of uncertainty about what is required” under the law and the interim rules.


We need a final set of fair and effective rules for the law this year. And if we can’t yet have final rules in all areas, we badly need them as soon as possible on scope of services. Without additional regulatory clarity on scope of services, confusion and varying interpretations will remain for service beneficiaries, families, providers, employers and insurers. Additionally, the trend that’s been seen in actual service reductions for intensive care need levels will worsen.


Mental health problems are growing, not decreasing, in our state and country. The poor economy, which has hit Michigan especially hard, has had a negative effect on the mental health of many people. And we are seeing returning veterans from Iraq and Afghanistan coming home with severe mental health problems. Michigan has the 11th largest veteran population in the country, and we know that 70% of veterans get their care in the private sector.


The Domenici-Wellstone parity act of 2008, to which then-Representative Kennedy greatly contributed, was a source of satisfaction and pride in the mental health community. And the Affordable Care Act then brought hope that what wasn’t covered by Domenici-Wellstone would be better addressed come 2014. But today, in 2012, much work remains to be done.  Michigan, unlike most of the country, has no state law to supplement Domenici-Wellstone. The three departments that were given a follow-up role for the federal law have been unable – or unwilling in Washington’s anti-regulatory climate – to develop fair and effective final rules for that law. And now the Supreme Court may gut the Affordable Care Act.


It is time for Michigan legislators to stand up to the Chamber of Commerce and the UAW on mental health parity. It is time for the U.S. Departments of Human Services, Labor and Treasury to give us federal rules on the Domenici-Wellstone parity law that are consistent with the spirit and intent of that law. And if the Affordable Care Act cannot advance, it is time for Congress to come back with alternatives that help people who lack insurance or important elements of it, as opposed to just letting matters rest.


Thank you for this opportunity to make known views of Michigan’s mental health community, and for your thoughtful consideration.