Policy Exploration #1: Guide and Example Policy Report (MHPAEA)
Hello again! I felt a good place to start our policy examination journey would be an older, comprehensive aside to the Affordable Care Act: the Mental Health Parity Addiction and Equity Act. I thought it might be helpful to look at a very relevant, well-established piece of legislation to start, as well as further elaborate on my examination methods and terms to make this a useful reference in case of confusion on future reports. To begin, here is a guide to the heading terms I will use:
Overview - The overview section will always be a brief summary of the policy itself, meant to discuss its basic technical details (exg. is it standalone, an extension/amendment to an existing law, etc.) and primary functions, as well as occasionally summarizing its legislative history. Fine details are often kept to a minimum to keep things as concise as possible, as the full breadth of policy can often be extremely specific and longwinded, but the core information will always be presented here.
Beneficiaries - The beneficiaries of any given policy are any given entity which benefits from it in any way, typically directly and sometimes indirectly. The beneficiaries section highlights these entities and explains how. This may seem pretty straightfoward, and it usually is, but it can be very easy to conflate beneficiaries with targets, which refers to any entity who are explicitly bound by the policy in question via its text and instruments. While the two go hand in hand, beneficiaries of policy are often not specifically targeted by the law. (This is the case with the MHPAEA, and the difference will be highlighted more below.) Potential beneficiaries of policy that are not also targets are rarely explicitly referred to within the policy. Furthermore, particularly when discussing federal legislation, those who benefit can be extremely varied and broad. This is also not to mention that almost any law can be argued to benefit "everyone" or "the people" or a similarly general statement by virtue of this being a democratic system, but typically I won't include statements like this because of their debatable nature and/or universal applicability. Despite the lengthy explanation, the beneficiaries section will tend to be brief and try to capture as many of the most relevant benefactors as possible.
Targets - As discussed above, targets are any explicitly outlined entities subject to the instruments of the policy in question, and the targets section lays these out. Targets can be similarly diverse to beneficiaries, but tend to be a lot more specific in nature, as laws are often as comprehensive as possible. To reiterate the difference, beneficiaries are always considered in policymaking, but they often aren't legally bound by the law benefitting them or are mentioned within the text of the law. Targets are those whom the policy is carried out on, so-to-speak, and are always laid out in the text.
Instruments - Instruments refer to the legal instruments by which the law is implemented or carried out on targets. This can refer to a wide variety of legal structures, such as:
- Any and all adjudication procedures specific to the policy (meaning how the policy should be treated in judiciary settings)
- New or altered rules/regulations
- New or altered incentives or disincentives
- New or altered penalties or sanctions for breaking rules/regulations
- New or altered interfacing processes between legal entities (exg. businesses, branches of government, individuals, etc.)
- Any other legal constructions meant to change, implement or execute law
While highly variable, instruments are usually readily apparent, as the plain-text of policy tends to be almost entirely composed of instrument description.
Outcomes - The outcomes section will outline expected outcomes of the law. In each report, the section will be split between a short summary of explicitly intended outcomes as outlined in the policy and/or by its authors/proponents, and then an often longer section elaborating on potential unintended outcomes, usually utilizing research presented by relevant advocates. Outcomes are normally unambiguous, but it bears note that unintended outcomes are never outlined within policy itself and are often diverse, specific, and debatable. For the sake of simplicity, like the beneficiaries section, I will avoid citing overarching or overly-ostensible sentiments (exg. 'this law will be good/bad for the economy', 'this bill will decrease profits for insurance companies', etc.) I will also try to remain impartial and present the most relevant and/or well-researched arguments, at least within the section. For laws that have already passed, I won't frequently offer a very critical examination for unintended consequences, as many will have come to pass and not be as relevant anymore.
Speculation - The speculation section will depart some from the more formal formatting of the above sections and offer what I believe to be its relevance to Telebehavioral Health US, as well my own thoughts/feelings on the meaning or context of the policy. Depending on the legislation, this section can vary a great deal, but I will try my best to keep it concise (if not succinct) and always cite sources as needed. If and when we move into more active political advocacy as Susie and I have been discussing, I may also use the speculation section to discuss what I think we could do to have our voice better heard regarding laws that affect us and/or our clients or reformulation suggestions. However, since I am by no means a legal scholar, I highly encourage readers to take my more personal words with a grain of salt, and note that my opinions don't necessarily represent those of TBH at large.
Hopefully the above glossary and example below will prove useful if you ever have trouble understanding what's going in future reports! Depending on the nature of the policy being examined, the overall length, details, and specificities of the sections may vary, but again, these should provide an excellent point of reference. If you ever have any questions or would like to conscript me to do research a particular policy (either to be published as a report in the series or as a more personal action,) please do not hesitate to send me a message via Slack or email me at email@example.com! Without further ado, here is the example report, adapted from a different report I did as an assignment for a healthcare policy class:
Summary Report on the Mental Health Parity and Addiction Equity Act
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a preservation and extension of the Mental Parity Act of 1996 (MHPA.) The MHPA provided consumers with a protection against the imposition by large group health plans of annual or lifetime dollar limits on mental health benefits that were any less favorable than comparable limits imposed on other medical benefits; the MHPAEA preserves this protection and expands parity requirements to substance use disorders. It does NOT require large group health plans or insurers to cover mental health or substance use disorder benefits- the MHPAEA’s requirements only apply to plans and insurers that choose to have such benefits in their benefits packages, as a provision for requiring coverage in general is contained within the Patient Protection and Affordable Care Act. After a process of amendments and corrections, the bill was signed into law on 23DEC2008, and the final regulation implementing the law was published in the Federal Register on 13NOV2013, making it effective for plan years starting 01JUL2014 and forward.
The beneficiaries of this policy are consumers or potential consumers wishing to access substance abuse services as part of mental health services, as the policy protects them from dollar limits on these services.
The targets of the MHPAEA include insurance companies and companies with large group health plans. Such companies are the only entities directly affected by the increased consumer protections, as they are responsible for following them. The MHPAEA does not directly affect small group health plans, but comparable requirements are applied indirectly by the concurrent Affordable Care Act.
The MHPAEA amends the MHPA, Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to impose its requirements. Accountability is monitored via entities such as the Centers for Medicare and Medicaid Services.
The intended outcomes of the law center on improving ease of access to and maintenance of mental health services for consumers - particularly substance use disorder services - by building on prior afforded protections and working in tandem with those afforded by provisions of the ACA. In turn, the MHPAEA aims to improve access to mental health services and improve mental health of consumers as a broader goal.
Laws like the MHPAEA are the foundation of businesses like ours, and it would be difficult for us to operate and even more difficult for people to access care period without the basic protections offered by them. We have a severe epidemic of lack of access to needed health resources in this country - substance abuse services in particular - and insurance companies making a killing by making it even more difficult in denying coverage and feeding into this issue. It is therefore my belief that any legislation that increases the ability of the populace to access health resources, at the expense of large insurers or not, is a consummate good, even if they're small, broad, or don't do enough. Such laws are our principle enablement and the principle protection of the people, and we should therefore work to maintain them, ensure the passage of new ones and fight their repeal.