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- Dec 31, 2022
In today's episode of "Revisionist History with Tony Reed"
Limits on insurance benefits date back to the inception of third-party payment for mental health services (Ridgely and Goldman 1989). Not until after World War II did insurance policies include mental health services, when insurers began covering some hospital psychiatric care (Goldman, Sharfstein, and Frank 1983). Before the period of deinstitutionalization, beginning in the late 1950s when most long-term care in psychiatric hospitals was replaced with community-based mental health care, there was little incentive for private insurers to cover services already paid for through the public sector (Frank, Koyangi, and McGuire 1997). But even though the proportion of private firms that include mental health and substance abuse coverage in their benefit packages has increased dramatically over the last thirty years, the National Compensation Survey conducted by the U.S. Bureau of Labor Statistics indicates that day and visit limits have become more stringent over time (U.S. Bureau of Labor Statistics 1982, 2007). One survey conducted before the MHPAE law was enacted found that 74 percent of workers in employer-sponsored health plans with mental health benefits were subject to an annual outpatient visit limit, 64 percent were subject to an inpatient day limit, and 22 percent had higher cost sharing for mental health benefits than for general medical benefits (Barry et al. 2003).
A Political History of Federal Mental Health and Addiction Insurance Parity
Limits on insurance benefits date back to the inception of third-party payment for mental health services (Ridgely and Goldman 1989). Not until after World War II did insurance policies include mental health services, when insurers began covering some hospital psychiatric care (Goldman, Sharfstein, and Frank 1983). Before the period of deinstitutionalization, beginning in the late 1950s when most long-term care in psychiatric hospitals was replaced with community-based mental health care, there was little incentive for private insurers to cover services already paid for through the public sector (Frank, Koyangi, and McGuire 1997). But even though the proportion of private firms that include mental health and substance abuse coverage in their benefit packages has increased dramatically over the last thirty years, the National Compensation Survey conducted by the U.S. Bureau of Labor Statistics indicates that day and visit limits have become more stringent over time (U.S. Bureau of Labor Statistics 1982, 2007). One survey conducted before the MHPAE law was enacted found that 74 percent of workers in employer-sponsored health plans with mental health benefits were subject to an annual outpatient visit limit, 64 percent were subject to an inpatient day limit, and 22 percent had higher cost sharing for mental health benefits than for general medical benefits (Barry et al. 2003).
A Political History of Federal Mental Health and Addiction Insurance Parity