We’ve all heard about health care reform passing in Congress and being signed into law.  We’ve also heard a lot of conflicting reports on what will happen.  The reality is going to be somewhere in the middle of the rhetoric. At MHAM, we see the following as the key impacts on mental health services in Minnesota:

• Expanded funding and eligibility for Medicare and Medicaid.  Right now, this may be one of the big impacts: as federal money comes into Minnesota, we need to make a strong case for why some of those dollars should stay in health care and human services, and help ease the cuts we have seen in the past biennium.  As we’ve noted, DFL leaders in Minnesota are very optimistic about the state’s ability to conform to new standards for treatment of chronic illnesses, including mental health and concurrent conditions.  This may also help ease the continuing GAMC crisis, by moving more of that population onto federal programs.

• Moving towards more parity for mental health.  While the authors  clearly intended to end specific exclusions of illnesses and expand coverage of pre-existing conditions, insurance companies announced attempts to find alternate ways of denying coverage. The Administration pushed back, and the insurance companies have retreated on these claims.  We will be alert to future conflicts over the intent of the legislation: fighting enhanced coverage for children with serious conditions is widely unpopular, but other provisions may not attract such immediate condemnation.

• Broadens requirements for coverage of preventive health care.  Insurance companies will be required to fully cover (with no co-pay or deductible) services that are shown to be effective in improving public health. Currently, this would include screening for depression in many circumstances.

• Extends coverage under group plans to age 26.  Children can stay on their parent’s health plans until age 26.  For many young people, especially in a slow job market, it has been difficult to maintain health insurance.  While these are relatively healthy years for most people, it is also an age when mental health conditions may emerge or require treatment.

• Prohibits rescission.  Rescission is the practice of ending a health care policy retroactively when large claims are made on the basis that the person did not correctly apply for the policy, even if it has been a long time since coverage started.  If a person gets very sick, some insurance companies will review their application, searching for any mistakes.  While it is important that people are honest and pay in fairly for their coverage, this practice exemplified the lack of power individuals had when seeking health care.  This is also a critical reform for anyone who may encounter a period of higher claims, such as inpatient hospitalization or intensive services for mental illnesses.

These bills are quite complex, and as we’re already seeing, may have effects different than President Obama intended.  The debate has been extremely contentious, and companies with their profits at risk are not going to simply back down.  It is important for mental health advocates to continue to be visible in the ongoing debate about how health care reform is going to work. For instance, Medicaid is being expanded, but it will take action by the state to make sure that there are workers available for the program that assesses applicants for eligibility. MHAM will work to make sure the promise of these changes is not lost for Minnesotans with mental illnesses.

For more information, you may want to attend (or listen to the online audio) of the Minnesota Senate Health and Human Services Budget Division on April 8th.  Sen. Linda Berglin is holding a meeting focused on the effects of these bills on the state.