More than a few people, at least in our field, have noticed that the long-anticipated release of interim final regulations for implementing the Wellstone-Domenici Mental Health and Addiction Equity Act by the Departments of Labor, Treasury, and Health and Human Services seems to be plagued by continued delays. First, regulators missed a legislated October 1, 2009, release. Then, the extended, early-January deadline also passed by without the release of regulations.
While some inside the Beltway continue to maintain that their release is imminent, other observers say we could be in for a significant wait.
Among the pessimists is Patrick Gauthier, senior consultant at AHP Behavioral Health Consulting of Palm Desert, Calif. He believes that the parity implementation regulations, while of vital importance to the behavioral health and addiction treatment fields, are just one “relatively small issue” in a larger drama involving the economic mess and uncertainties about the future of healthcare reform.
“Parity is great for everyone involved in the behavioral health and substance abuse field, but it is a relatively small issue compared to healthcare reform,” he says. “I believe that the Administration feels that release of these regulations now just compounds the difficulty of ‘managing the message’ until healthcare reform is resolved.
“There are titanic forces involved right now in Washington. Health insurance reform has taken far longer than expected and its opponents have generated a great deal of momentum.” He explains that in addition to predictable partisan opposition in Congress, opponents are pressing the attack through the “Tea Party” movement, angry rallies, and even a proposed constitutional test. One provision of the proposed legislation, the tax on “Cadillac” health plans, has even generated strong and unexpected opposition among union members, who have generally supported the Administration and the reform effort. “When you add all of this to the war on terror, the economic crisis, and the recent Massachusetts election result,” says Gauthier, “there’s no breathing room for the Administration in terms of getting this [healthcare reform] right.”
While parity brings important help to those with behavioral health and addiction treatment needs, Gauthier explains that “it’s also something of a nuisance” to the health plans that “face a great deal of work internally to comply with it.” The release of the regulations—which define parity requirements not only for private health plans, but for both proposed healthcare reform bills—could provoke additional and unwelcome criticism. Already, private health plans have had to develop their solutions for parity in the absence of the regulatory guidance due last fall in order to comply with parity requirements by January 1, 2010.
At the same time, Gauthier explains that private health plans were also coping with another new congressional mandate. To aid the millions of Americans that lost their jobs in the economic meltdown, Congress extended unemployment benefits and mandated an extension of reduced-premium COBRA health insurance coverage for recently terminated workers from nine to 15 months. Says Gauthier: “Health plans argue that mandates like this produce mountains of unfunded work and expenses. And, they have to do the work and cover the additional claims without any additional cash coming in.”
The cascade of all the uncertainty, compounded by as-yet unresolved scenarios for healthcare reform, has tempers running high and patience running low throughout D.C., placing extra pressure on Administration officials—many of whom have served only months in their positions—to say just the right thing at just the right time. In this atmosphere, Gauthier says, timing is everything for the new parity regulations. “If something is put out that’s not perfect, it will be cut to mincemeat by all of these angry lobbies. And, the one thing about regulations is that they’re never perfect.”
If Gauthier is correct, we might well see the release of parity regulations delayed further still, a hostage to the outcome of the greater healthcare debate. If not, they could be in for a rough reception.