State activism on federal rules: mental health & substance use

Problems affording health insurance with 7% rate hikes this year?

Fed up with privacy violations and protocols that deny your healthcare choices?

No worries. The State of Michigan has your back, in the back-stabbing sense. They are doubling down on data collection and mandates, driving rates even higher.

Ten years ago, an industry insider pegged Michigan coverage mandates at raising rates 4% per mandate, on average. (Pre-ACA, Michigan had enough mandates to more than double insurance rates. The ACA added to that number.)

The kicker about mandates is the way they remove choice. No ala carte insurance choices for you! 

This year, proposed federal rules would add mandates for mental health and substance use disorder. Given the high numbers and low cure rates, the new mandates are guaranteed to make health premiums much less affordable. 

Even more concerning, whatever is covered has data collected for federal and industry use. The initial privacy violation comes back to bite us with protocols defining our care. 

This week the State of Michigan chose to brag up its comments on the proposed rules.

Governor Whitmer, DIFS Announce Support for Expanded Insurance Coverage of Mental Health Services

Media Contact: Laura Hall, (517) 290-3779, DIFS-press@michigan.gov 
Consumer Hotline: 877-999-6442, Michigan.gov/DIFScomplaints

FOR IMMEDIATE RELEASE: October 24, 2023

(LANSING, MICH) The Michigan Department of Insurance and Financial Services has submitted comments to the U.S. Department of Labor’s Employee Benefits Security Administration expressing support for newly proposed federal rules that will help improve access to timely high-quality mental health and substance use disorder treatments.

"Every Michiganders deserves access to quality affordable health care, which includes coverage for mental health and substance use disorders,” said Governor Gretchen Whitmer. “These proposed rules from the Biden-Harris Administration will help more Michiganders get the care they need to get better and prioritize their overall wellbeing. We will keep working with our federal and state partners, including insurers and other stakeholders, to lower costs, expand coverage, and build a healthier, safer Michigan.”

"Mental health care is just as important as physical health care, and we will continue to do everything within our power to ensure that Michiganders can get coverage for the treatments they need to stay healthy,” said Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox. “I am pleased to offer the Department’s support for these important rules and to make suggestions to further strengthen consumer protections to ensure that those who need these services have coverage on the same basis as other covered benefits such as cancer screenings and office visits.”

First passed in 2008, and later expanded in 2010 and 2021, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires most health insurers and plans to cover mental health and substance use disorder treatments without cost or use restrictions that are more restrictive than those applied to other covered treatments. The expanded law also put into place testing and data reporting requirements to help state agencies, including DIFS, and the federal government implement these rules.

The newly proposed rules further strengthen the consumer protections under MHPAEA by adding additional controls to the use of treatment limitations, such as prior authorization requirements, standards for provider admission to insurance networks, and methodologies for determining provider reimbursement rates. The proposed rules would also put into place an additional data reporting requirement that would have insurers collect and evaluate relevant outcomes data, identify any material differences between the types of benefits, and remedy any identified differences.

If finalized, the new requirements will go into effect on January 1, 2025, for group health plans, and on January 1, 2026, for individual health plans.

NOTE: "newly-proposed" language notwithstanding, the public comment period for this rule CLOSED on October 2, 2023.

Options for citizen activism include contacting elected representatives in the US Congress and Michigan legislature.