Congress this year will again take up the Substance Abuse Treatment Parity Act of 1997, which would require health insurance coverage for drug and alcohol treatment to conform to medical and surgical benefits.
The bill, which remains in committee in both the House and Senate, would "level the playing field when it comes to treatment of addiction with other major chronic illnesses," said William Moyers, director of public policy for the Hazelden Foundation, a not-for-profit alcohol and drug addiction treatment provider based in Center City, Minn.
Introduced Sept. 4 by Sen. Paul Wellstone (D-Minn.) and Rep. Jim Ramstad (R-Minn.), the proposed legislation would prohibit group health plans from imposing annual or lifetime dollar limits, copayments, deductibles or visit limits for substance abuse rehabilitation unless similar requirements exist for other medical and surgical benefits.
While opponents believe the bill would be too costly, the actuarial firm Milliman & Robertson found the additional coverage would increase health insurance premiums by only 0.5%, or less than $1 per enrollee per month. In addition, the bill would not require health plans to offer substance abuse benefits. Rather, it would require plans that already cover chemical dependency to treat it equally with all other covered illnesses.
Many plans now cover only detoxification programs. But such programs are not as effective as those that include counseling to modify behavior, said Jane Nakken, executive vice president for external relations at the Hazelden Foundation.
In the long run, the bill might save more than it costs, in dollars and lives. Of all general hospital patients, 25% to 40% suffer from alcoholism-related complications, according to a 1996 report by the President's Commission on Model State Drug Laws. In addition, 65% of emergency room visits are alcohol or drug related, the commission found.
In addition, the report said substance abuse costs American businesses nearly $100 billion in increased medical claims, medical disability, injuries, theft, absenteeism and decreased productivity. After treatment, however, absenteeism, disability days and disciplinary actions all decrease by more than 50%.
Along with Hazelden, the Betty Ford Center, based in Rancho Mirage, Calif., and the Valley Hope Association, based in Norton, Kan., have created the Partnership for Recovery coalition to lobby for bills like this one and promote public understanding of drug and alcohol addiction.
But some supporters of substance abuse parity say the proposed legislation is flawed. It does not define substance abuse nor does it refer to medical necessity or the need for clinical management of care.
"We have trouble defending an open-ended parity and cannot endorse the legislation until the two issues are addressed," said E. Clarke Ross, executive director of the American Managed Behavioral Healthcare Association, which represents 17 companies serving more than 80 million enrollees. "The more silent we are, the more opponents have legitimate reasons to oppose the act."
The American Association of Health Plans has no official stand on the proposed legislation.
If the bill becomes law, costs and fear of fraud might inadvertently cause health plans to drop chemical dependency treatment from their coverage. But lobbyists are not afraid of such a scenario, Moyers said.
"The smart plans really understand the nature of addiction," Moyers said. "Addiction is the root cause of so many other health problems. They realize how important it is in controlling those other problems."