Labor Day Thoughts on Mental Health Policy and the Workforce

Care for Your Mind

young woman in computer lab

As we return from the Labor Day holiday and our annual tribute to the contributions of workers to the strength, prosperity, and well-being of our country, it’s fitting to take a quick look at mental health policy issues for employees. The Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act of 2010 (ACA) presented new opportunities for people to receive mental health care from their employer-provided health coverage. The Mental Health Parity law attempts to level the field between medical/surgical health care and care for mental health and substance use disorders, while the ACA aims to open access to affordable health care, including behavioral health care services, for more people. Both of these laws come into play, in part, through employees’ health insurance benefits.

Fewer people are getting health insurance through work.

In our society, employers play a critical role in creating access to health care, as most people with health insurance have it through either their work or their spouse’s work. However, since 2000, the percentage of people who have health insurance through their employers has declined dramatically, from nearly 70% to just under 60%. According to a study by the Robert Wood Johnson Foundation, “11.5 million fewer Americans receive their health coverage through their job, or a family member’s job, than did at the start of the century,” dropping 170.5 million in 2000 159 million in 2011.

As the Affordable Care Act health coverage opportunities and requirements come into effect, the implications for employers—and employees—are significant. (The Department of Labor has extensive information for employers and employees.) Although employers are not mandated to provide health benefits to employees, many businesses with at least 50 full-time employees may face penalties for failing to provide affordable health coverage by 2015. Some employers are implementing layoffs or reducing employees’ hours so that the health coverage provisions will not apply, claiming untenable financial burden.

We need to make sure that businesses understand what is—and what is not—required of them under the new health care law. Skeptics and alarmists leverage fear and lack of understanding. We can counteract misleading information with accurate information that helps people get the health care they need and helps businesses to thrive.

Mental health parity doesn’t mean equality, but it helps.

The Mental Health Parity and Addiction Equity Act had lofty goals but limited requirements. (This page from SAMHSA has a good overview.) Delays in producing the Act’s regulations allowed continuing confusion and failures in implementation. Also, the Parity Act did not require that mental health or substance use disorder services be provided, only that if they did, the coverage would need to be no less restrictive than for medical/surgical services.

In the nearly 5 years since its passage, many employers (through their insurers) have made significant strides in implementing the Parity Act. A great deal of information is available to support employers and group health insurers in making mental health parity a reality. Employees with questions or concerns can refer to this set of FAQs from the Parity Implementation Coalition.

Looking forward, the Affordable Care Act helps to extend the availability of mental health care and substance use disorder care by requiring they be included as one of the “essential health benefits” in any health care coverage.

Business buy-in and well-informed health care consumers will make implementation of the ACA happen more quickly and more effectively.

Preventive health programs help employees and businesses.

A growing number of employers offer some form of wellness program and those that do believe that wellness programs help to manage their health care costs. (See Kaiser Family Foundation 2013 Employer Health Benefits Survey). Employers are able to positively affect employees’ mental health by offering stress-management and mindfulness classes, exercise and fitness programs, mental health screening programs, employee assistance programs, sane work hour policies, and more. Final regulations have been issued to guide employers in designing and implementing wellness programs.

Human resources and employee benefits managers can find ample evidence pointing to the value of wellness programs and scores of wellness programs ideas. Often, health insurance companies can provide frameworks and assistance to support businesses adopting wellness programs. There are also a variety of free or low-cost mental wellness programs available from nonprofit organizations. (See our earlier posts on workplace mental health here and here.)

Bringing better mental health care and mental wellness to our country’s workers and their families can be achieved. Let’s be inspired by the reasons for Labor Day to renew our efforts to making mental health care accessible and improving mental health for all.

What, if any, wellness programs or incentives does your employer offer? What challenges are you still facing regarding equal coverage for mental health compare to physical health needs?

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1 comments
phyllisfoxworth
phyllisfoxworth

Having worked for a major corporation that attracts and retains talent by providing high quality  health insurance,  our family was the direct recipient of the Parity Act.  When our daughter had a mental health crises in late 2010, I was told by our insurance provider, in January 2011 that my health insurance policy had no restrictions on the number of visits or limits on how many different mental health professionals she could see.  As a result she was able to attend a partial hospitalization program for 8 months while at the same time seeing her psychiatrist several times a week as well as her therapist.  When I asked about any restrictions or limits in the mental health coverage, I was told by the Blue Cross Blue Shield representative I spoke with on the phone. THERE ARE NO RESTRICTIONS OR LIMITS.  THAT'S THE LAW!

Next up, we  need to make sure ALL Americans have access to high quality insurance, not just those Americans who happen to be fortunate enough to work for organizations that feel ethically bound to provide this benefit to their employees.