January 5th, 2020

Hearing raises issue of parity, insurance rates

As required by state law, the New Hampshire Insurance Department (NHID) hosts a public hearing each year to talk about health care costs and trends. The 2019 hearing, held in October, focused on the number of residents covered by insurance and the state’s progress on mental health parity.

Eireann Sibley NHID communications director noted that the hearings are for the public and regular attendees include insurance company representatives, providers, academics, health care advocates, and legislators.

According to published reports culled from data submitted by health insurance companies, the uninsured rate in New Hampshire did not change drastically in 2018 from the previous year and it remains lower than the national average at 5.7 percent.

A bigger concern is that insurance rates for the individual market rose by 45 percent in New Hampshire this year. This rate is steeper than the national average of a 25 percent increase.

One insurer left the market in late 2017 plus the elimination of the cost-sharing reduction subsidies at a federal level caused increases in premiums. And this trend may continue.

“Premium rates may continue to rise as the costs of health care rise,” said Sibley.

In addition to the update on insurance premiums, the hearing also welcomed Harvard Medical School’s Richard Frank, Ph.D, the Margaret T. Morris professor of health economics, to talk about mental health parity.

“Access to mental health and substance use disorder services is important in New Hampshire, partially due to the opioid crisis,” said Sibley.

The good news is that, since parity was made federal law in 2008, there have been demonstrable changes in the way insurance companies provide coverage for mental health care.

Care for children has increased, cost sharing and limits to number of visits have decreased, and out of pocket spending by clients had decreased even with increased use of mental health coverage, among other things.

Still, there have been issues with coverage since parity only means mental health coverage needs to be as good as that plan’s physical health coverage. Another issue lies in the fact that mental health care is harder to strictly control – too few rules can lead to difficulty with keeping costs under control but proper treatment needs to be a more individualized than with physical health care.

Frank suggested that the system needs to be supported with better community care and housing. Insurers should be paid better to take on more mental health care clients and more oversight to ensure accountability is needed.

Whether further regulation is enough to bring about true parity is the real question, though, and Frank doubts it.

“Can we get there?” he said. “I would say I think we can be a lot fairer than we have been. But it depends on a variety of other social forces including stigma. I don’t know when and if we can get there but I think we can go a long way down the road to making access to quality mental health care a lot better and fairer than it is now.”

By Catherine Robertson Souter

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