One of the major recommendations outlined in the final report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis is the need for greater enforcement of the Federal Parity Act. Next year will mark the 10th anniversary of the landmark legislation, which mandates that health insurance plans’ standards for substance use and mental health benefits be comparable to, and be no more restrictive than, the standards for other medical/surgical benefits. The purpose of the Parity Act is to prevent discriminatory insurance coverage for those with mental health and substance use disorders, but it must be effectively enforced in order to achieve this objective.
“The campaign is ready to jumpstart parity enforcement,” said Ellen Weber, vice president for health initiatives at the Legal Action Center and the director of the campaign. “Achieving more robust parity compliance in 10 states over the next three years will not only benefit millions of people living in those states, but will also establish models that can be adopted by other states.”
Parity@10 will launch in five states – Illinois, Maryland, New Jersey, New York and Ohio, with a key anchor organization working in each state in the first year of the campaign. An additional five states will be added in the second year. The campaign’s work in each state will be broad, ranging from researching the current treatment and policy landscape to conducting extensive public and provider education about the Parity Act, to working with legislators, regulators and Attorneys General to develop more effective compliance and enforcement frameworks.
“Every day, more than 290 Americans will die from either a drug overdose or suicide. We cannot wait one more minute to take action,” says Patrick J. Kennedy, founder of The Kennedy Forum and a member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. “It is way past time to enforce this law. We need to move from a system that relies on people in the middle of personal turmoil to identify wrongdoing to one that is grounded in proactive enforcement of the law—involving state attorneys general, state insurance commissioners, and the Department of Labor.” Kennedy is a former member of the U.S. House of Representatives and was a lead sponsor of the Parity Act.
The current enforcement framework primarily relies on consumers to raise issues with Parity Act compliance, but a recent analysis found that insurance plan documents do not generally provide the information necessary for consumers to determine whether their coverage complies with the law. The Parity@10 Campaign will advocate for state regulators to shift to a pre-market, prospective regulatory review process to ensure that plans are complying with the Parity Act before they are sold, rather than continuing to place the burden on consumers to identify Parity Act violations and assert their right to care in the midst of a health crisis.
Denise Mariano, a mother from New Jersey and a parent coach for the Partnership for Drug-Free Kids, fought for two years to get her insurer to cover her son’s treatment for opioid addiction, draining her family’s financial resources to pay for out of pocket care as she battled insurance denials.
“My child was battling a life-threatening disease; he was personally begging for help and my insurance company said that treatment wasn’t ‘medically necessary.’” She adds, “We were the lucky ones – we had the means to pay now and fight later – if we hadn’t been able to do that our son would probably not be here today, instead he lives a full and beautiful life in recovery. My family is still climbing out of debt for care that insurance should have covered. The model doesn’t work – people are dying every day waiting for their insurance companies to approve the care that they are entitled to receive under the law.”
The initial phase of the Parity@10 Campaign is partially funded by each of the following entities: Indivior, Inc., The New York Community Trust, the Open Society U.S. Programs and the Open Society Institute-Baltimore.