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This past legislative session, several Idaho lawmakers expressed serious and valid concern over the rise in mental illness and suicide throughout the state. In 2017, 393 Idahoans died from suicide, placing the state fifth-highest in the country in suicide-related deaths.
While Idaho has taken necessary and helpful steps in attempting to address this issue, such as establishing a 24/7 suicide prevention hotline and several crisis centers, there’s more we can and should do to improve mental health outcomes for patients in our state. One of the top priorities should be enforcing mental health parity laws that exist today.
Mental health parity can be a confusing topic to discuss. At their most basic level, parity laws exist to ensure that insurance benefits for mental health and substance-use conditions are equal to coverage for other illnesses. For example, if your insurance plan offers unlimited visits for a chronic condition such as diabetes, then it must also offer unlimited visits for conditions such as depression and schizophrenia.
When I was in the Legislature, several of my Republican and Democratic colleagues and I passed House Bill 615 in 2006, ensuring parity for state employees and their families. Then, in 2008, Congress passed the Mental Health Parity and Addiction Equality Act (MHPAEA). This federal law was supposed to enforce parity between mental and physical health.
However, the problem with MHPAEA centers on a lack of uniform enforcement of the law across the country. When the Affordable Care Act included mental health and substance use as an essential benefit, it came with the assumption that parity would be more easily actualized in practice by insurance companies. Unfortunately, this hasn’t worked out as planned.
We have seen the direct repercussions of a lack of parity enforcement here in Idaho. In 2017, Milliman, an international consulting firm, found reimbursement rates for mental health and substance use through private insurance were far lower than for other medical providers. When insurance plans lack adequate reimbursement rates, most providers decline to even participate in the network.
The lack of higher reimbursement is major contributor to the leading problem we face today in our state: a severe lack of adequate mental health and substance-use providers for folks who are in need. In fact, according to the Health Resources & Services Administration, every county in Idaho is designated as a mental health provider shortage area, with many Idahoans in counties having to drive several hours to the nearest facility – which may or may not be in their insurance network, leaving many Idahoans with very limited options to address their needs.
Certainly there are other steps we can and must take to address this growing but preventable crisis head-on in the years to come. Establishing comprehensive, enforceable parity laws to ensure greater access to quality mental health and substance-use care is a common-sense and meaningful option that can make a world of a difference in the lives of thousands of Idahoans.
Kathie Garrett is a former Idaho legislator who was vice chairwoman of the House Health and Welfare Committee. She has won numerous state awards related to mental health, including “Lifetime Advocacy Achievement Award” from the Idaho Federation of Families for Children’s Mental Health in 2017.