I didn't start out Tuesday morning by planning to get so angry. But anger found me at breakfast, when I saw a blog by Merrill Matthews, an expert health policy blogger for Forbes magazine. In the piece, one of a series that speak against recent health reforms, Merrill stated that the recent announcement of mental health parity regulations is an invitation to “overtreatment and fraud . . . a desperate effort to redirect people’s attention from the Obamacare rollout.”
As I read on, Matthews, the former head of the Council for Affordable Health Insurance, who is now a principal at the Dallas-based Institute for Policy Innovation, laments the loss of the “state-based mental health mandate [which] usually operated in an environment where health insurers could deny coverage for a pre-existing condition.” He frets that this change, combined with the issuance of final parity regs and evolving Obamacare reforms, “means that people with mental health, substance abuse and behavioral issues can sign up—well, if the bureaucrats ever get the website fixed— for subsidized coverage with very few limits."
Matthews pushes several threats in his piece: that the federal parity mandate will result in more fraud and higher costs for insurers because behavioral health conditions are more difficult to conclusively treat than say, broken bones; that policyholders will pay "more" for policies that include parity level mental health/substance abuse treatment benefits; and that new policies that include parity-level benefits will cause cancellation of older, perhaps less expensive, policies.
To bolster his point about the specter of mental health fraud, Matthews cites three stories. What he fails to mention, however, is that all of these stories involve Medicare and Medicaid, not commercial insurance, and that in two of the stories, authorities had already suspended providers from payment using the tough new anti-fraud provisions of the Affordable Care Act (Obamacare). These provisions enable federal or state officials to halt Medicare or Medicaid payments immediately, based on “credible allegations of fraud,” without the need for arrests, niceties of due process, or even criminal charges. This fact – and the fact that mental health and addiction treatment account for just a few percentage points of national health spending – hardly make for an explosion of “mental health fraud,” even if many more get the treatment they need.
Matthews offers no similar accounts to bolster his case about the threat of behavioral health fraud to private insurers, whose limitations on behavioral health coverage triggered not one but two pieces of bipartisan parity legislation - one in the 1990s, and the latest one, whose passage dates from the Bush Administration.