The industry strives for a balance in cost and coverage so that the largest number of persons may be covered at an affordable level. In the case of parity for substance abuse, the scales of costs might tip that balance and then the number of persons covered begins to decline because of higher costs for coverage overall. In a voluntary marketplace for health coverage which we have today, the market is the driving force behind change and innovation. Adding benefit mandates, whether at the federal or state level, will continue to add to the cost of coverage. Each group, no matter how well intended, that advances one level of benefits often fails to see the effects of their advocacy for extended coverage as they relate to other group efforts.
Mandates can also affect health care plans differently depending on their organizational structure.
In a tightly managed care setting, such as an HMO, substance abuse parity would be subject to utilization review mechanisms that would allow for appropriate treatments after application of clinical guidelines to the patient's care. Yet, in the current legislative debate, costs containment features of many managed care plans have been under criticism. Often policy makers want to undermine the very managed care components that are designed to assure the appropriateness of the services provided. So on the one hand Congress wants more coverage, yet, with private health care plans, there is always the lingering criticism when plans manage benefit coverage. It is often surprising to me that Congress continues to propose certain mandated benefits and then exempt the mandates for some of the programs that they are responsible for - Medicare, Medicaid, the Federal Employees Health Benefits Program, and so on.