Former First Lady Rosalynn Carter Lauds Parity and the ACA / HHS Secretary Kathleen Sebelius Announces Final Parity Regulations

On November 7 and 8, Former First Lady Rosalynn Carter continued her unprecedented work on behalf of the mental health and substance use fields. On those dates, she hosted her 29th Annual Rosalynn Carter Mental Health Policy Symposium at the Carter Center in Atlanta, Georgia.   Her theme for the much-anticipated symposium was very timely this year: “The Road Ahead: Challenges and Opportunities for Behavioral Health Care during the Implementation of the Affordable Care Act (ACA).” This very exclusive two-day event examined three key features of the ACA and their implications for behavioral healthcare. The three ACA areas are Enrollment and Outreach, Access to Care, and Service Delivery, each a critical issue for persons with mental health or substance use conditions.

As we have learned over the past few years from the Massachusetts mandatory universal health insurance coverage program, persons with mental health and substance use conditions have greater difficulty than others in enrolling in health insurance and in accessing care.They also are subjected to considerable stigma. Hence, a major, as yet unanswered question for the field is whether we will be able to do better as we implement the ACA. The Symposium sought to look ahead and provide preliminary answers to these and other key questions.

In her opening remarks, the Former First Lady expressed strong hope for the ACA. She said, “We have been waiting for the Affordable Care Act for more than 33 years since the repeal of the Mental Health Systems Act in 1980. The ACA holds great potential for persons with mental health and substance use conditions. Now, we need to make it work and monitor developments.”    

As a special honor to Mrs. Carter, HHS Secretary Kathleen Sebelius traveled to Atlanta on Friday to use the Symposium venue for the historic announcement of the final parity regulations for the 2008 Wellstone-Domenici Mental Health Parity and Addiction Equity Act. The Secretary also used the occasion to praise the unprecedented efforts of the Former First Lady. In her closing, the Secretary said, “We have learned that good mental and addictive health are critical to overall health. That is why the ACA gives special consideration to both of these areas, and why the work of our Former First Lady has been so very important.”

In his inimitable way, Steve Sharfstein, President of Sheppard-Pratt, provided an historical overview of policy developments in the field over the past 150 years, and Joel Miller, the new Executive Director of the American Mental Health Counselors Association, framed the Symposium discussion into three key questions: Will persons with mental health or substance use conditions actually enroll in ACA health insurance programs? Will they have access to care? Will the available care meet their needs? Participants then began considering each of these topics.

Panel I: Enrollment and Outreach.  With 39 million Americans eligible for health insurance enrollment under the ACA, 11 million of whom already have behavioral health conditions, the field has a very major task of outreach and engagement.  What role can we play individually and collectively to help these populations enroll successfully?

Panel II: Access. Under the ACA, each person who is insured has a benefit floor defined by the state’s Essential Health Benefit. Further, mental health and substance use benefits must be at parity with medical and surgical benefits. With the implementation of parity, access should improve for persons with behavioral health conditions who are newly covered by ACA health insurance. How can we monitor this situation to assure that parity is actually present and operational, and that people actually have access to care?

Panel III: Service Delivery. Here, at least four questions emerge:  Are the benefits appropriate for the needs that are expressed by persons with behavioral health conditions? Are the services organized into an effective integrated service configuration, such as a health home operated by an accountable care organization? Have appropriate prevention and promotion services been made available? How can public health approaches contribute to this work?

Participants were very enthusiastic about the tremendous potential of the ACA to improve access and care for persons with mental health and substance use conditions. They also were reminded that we have much work to do to prepare our fields for the historic changes that are already underway.

As all of us have come to expect from these annual symposia, Mrs. Carter  again has challenged us to go into the field and do much better than we did previously. Fortunately, the ACA provides some esential new tools that will help us to do that.

I want to use this occasion to recognize and honor the Former First Lary for her more than four decades of continuous, outstanding leadership for the mental health and substance use fields. This is a record of service, unparalleled in our field, that has done so very much to reduce stigma and advance person-centered care, true recovery and wellness, and a full life in the community.  Thank you ever so much Mrs. Carter for your outstanding service to our community!