1 / 36

Non-Discrimination in Health Insurance

SB 549 ? 2004 Session. By Senator Paulette IronsRequires equal coverage to other medical illnessesNo exceptionsPermits and encourages Managed CareCriteria based levels of carei.e. - ASAM Patient Placement Criteria. Plan For Next Session. Contact Insurance lobbyContact Business

sanam
Download Presentation

Non-Discrimination in Health Insurance

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Non-Discrimination in Health Insurance Ken Roy, MD Addiction Recovery Resources of New Orleans River Oaks Hospital Tulane Department of Psychiatry kenroymd@bellsouth.net

    2. SB 549 – 2004 Session By Senator Paulette Irons Requires equal coverage to other medical illnesses No exceptions Permits and encourages Managed Care Criteria based levels of care i.e. - ASAM Patient Placement Criteria

    3. Plan For Next Session Contact Insurance lobby Contact Business & Industry lobby Attempt to develop more focused support from Medicine & Psychiatry Identify a passionate elected advocate Present an appropriate recovering person who benefited from treatment

    4. Parity Is The Solution Entitled “Non-Discrimination” The best and most humane and most effective way to actualize a market based solution to a social, economic and values-based problem Private sector solution

    5. JoinTogether.org Recommendations from a National Policy Panel ENDING DISCRIMINATION AGAINST PEOPLE WITH ALCOHOL AND DRUG PROBLEMS 2003

    6. What Has Happened Business and Insurance have abdicated treatment to the State 80% of treatment in LA is in the state system Less than 20% of people who ask for treatment actually receive it

    7. Who Is Affected Working people Family members of workers Tax payers Home owners

    8. Why Is Parity Needed 60% to 80% of workers medically indigent for substance abuse services Huge cost to business, industry and the healthcare delivery system

    9. EnsuringSolutions.org Problem drinking exacts a $9.2 billion toll on state budgets each year – greater than the costs of either illicit drugs or tobacco. Studies in 11 states show that this high fiscal burden can be substantially reduced by bringing private insurance coverage for alcohol problems inline with coverage for other illnesses. Although 80 percent of people who have alcohol use disorders work, and most individuals who seek treatment for addiction have health insurance through their employers, their health plans cover treatment for only a few.

    10. EnsuringSolutions.org Parity – health insurance that provides coverage of treatment for mental illnesses and substance abuse equal to coverage for other illnesses – could enable many more people to recover from their alcohol problems while resulting in significant savings to states and businesses. An extensive Ensuring Solutions analysis of 11 state studies on parity shows that its cost to insurers is negligible – raising annual premiums just 0.2 percent.

    11. EnsuringSolutions.org “The cost of parity is comparatively small when compared to overall health expenditures and when spread out over all enrolled members,” concluded California’s State Legislative Analyst’s Office after reviewing health insurance coverage of substance abuse treatment. Mandating parity would not place an undue burden on businesses that offer health insurance to their employees.

    12. EnsuringSolutions.org The analysis shows that: Equitable coverage reduces pressures on financially distressed states’ budgets (and the tax burden to states’ citizens and businesses). Oregon, for example, found the state saves $5.62 in tax-supported health, corrections and welfare costs for every state dollar spent Parity increases the number of people who receive treatment, thereby reducing their long-term cost to the state. In addition, more get treatment as outpatients and inpatients, while the length of (more expensive) hospital stays is sharply reduced.

    13. EnsuringSolutions.org A North Carolina legislative report concludes: “Studies from several states have consistently shown that appropriate treatment of chemical dependency results in a significant reduction in medical claims, absenteeism, and disability; an increase in productivity; and a healthier and safer environment for all employees.” According to a PricewaterhouseCoopers actuarial analysis, the cost of parity to individual businesses goes down sharply when all or most businesses in a state are required to have equal coverage.

    14. Why Parity Is Right Chronic disease Primary disease Relapsing disease Medical model

    16. What Has Been Done Legislatively 7 states have comprehensive parity legislation for addiction (CT, DE, ME, MN, VT, VA, WV.) 2 more have parity for state employees (NC, SC.) 12 or more states will file in their next sessions 15% - 20% of the country could be covered in the next 2 years

    17. Federal Efforts HEART Act – H 2256 & S 1138 Senate legislation is pending from Sen. Coleman (D-MN) for Mental Health House legislation is pending from rep. Roukema (R-NJ) & rep. Ramstad (R-MN) Federal employees have mandated coverage since 2001

    18. Proposed Activities Case finding – patients harmed by insurance restrictions Legislative contacts Self education www.caas.brown.edu/plndp www.jointogether.org www.health.org/pubs/insur/ www.ensuringsolutions.org

    19. Sample Presentation Package 1. Presentation Organizer (Avery 6 Pocket Organizer) 2. Lead page4 # 15 3. Non Discrimination Essay # 18 4. Chronic Disease Chart # 4 5. Mathematica Study #1b – Executive Summary 6. Chronic Disease Demands Chronic Treatment 7. NCSL Report # 17 – To help legislator (and you) understand the issues. 8. LA Non Disc04 #14 ˝ 9. EnsuringSolutions pb1 # 10 – The hook for budget conscious legislators. 10. Your card 11. A copy of this CD and the Contents (page #5.)

    20. Contents of Supporting Documents 1. Mathematica Study (folder) = SAMHSA study of parity in Vermont Table of Contents – Will give you origin information and links Executive Summary – Good info to know. It works! CD Parity costs less than 0.2% Conclusion – Treatment is scarce and needed. 2. Advocacy-Anonymity = A pamphlet for people in recovery showing how to advocate for legislation without breaking anonymity. 3. CD Record - A file for a CD burner to reproduce the CD. 4. Chronic treatment… = Support for chronic disease management model for addiction 5. Chronic disease chart = A comparison of the etiology, cost, prevalence and insurance coverage of chronic diseases. 6. Contents = This page. 7. Core Principles = A statement of what should be in a parity bill. 8. Disease Discrimination = A supporting paper for the HEART Act.

    21. Contents of Supporting Documents 9. Employment Based Insurance = GWU report on the benefits of effective treatment. 10. Ensuring Solutions… = A paper responding to the absence of treatment 11. Ensuring Solutions pb1 = Documentation that parity can save states money. 12. Ensuring Solutions prim1 = Documentation of the chronic disease management model. 13. Facts… = Another data sheet supporting parity. Links to grass roots organization. 14.JAMA Disease = The abstract of the McLellen article in JAMA 15. JTO Discrimination = A position paper with documentation along the lines that the absence of parity is discrimination. 16. Lead page4 = sample 1st page of a presentation package. 17. Millman Study = A well documented and respected study demonstrating the low costs of parity.

    22. Contents of Supporting Documents 18. NCSL Report = A discussion from the National Council of State Legislatures of the legislative issues in a parity effort. A good thing to know before talking to a legislator. 19. Non Discrimination Essay = An essay describing parity in non-discrimination language. 20. Non Discrimination Bullets = Facts and talking points. 21. PLNDP = Physicians’ Leadership on National Drug Policy – a nice printout. Good info. 22.Rand Report = Testimony to Congress on the absence of and need for parity. 23. Rand nejm = A paper showing that Substance Dependence is the disease with the least treatment 24. RWJF Chartbooks = A large and thorough discussion of the problem. The implication is that we haven’t made much progress because we don’t have parity.

    23. Contents of Supporting Documents 25. Sample Presentation Package = Suggestions for how to use this material. 26. U.S. Lacks Treatment For Elderly = Documentation of need in this group. 27. VT Employer = Brief discussion of employer issues in the Vermont parity experience. 28. VT Learn = A discussion of the issues of cost and access to care and managed care. 29. VT Parity = Full report of effects of Parity in Vermont. 30. WeNeedTreatment = A booklet advocating parity from New Hampshire. 31. White = A recruitment paper for grass roots efforts.

    24. How to Advocate Make an appointment with your legislator Have a presentation package prepared Plan on a brief (15 minutes) presentation Make one or two points Tell him/her about a patient or two Make a follow-up appointment Leave the package

    25. Contribute Become involved in the political process That usually means contributing to your legislator Offer to be a resource to him/her for issues of addiction Plan regular contact

More Related