THE PROGNOSIS

Ten years ago, Congress passed a law requiring insurance companies to cover behavioral health conditions in the same way they covered physical conditions. And there seems to have been some progress — in the years since, use of treatment services for mental illness and substance use disorders has skyrocketed.

A new study from independent nonprofit FAIR Health analyzed individual procedures or services covered by private insurance companies from 2007 to 2017. In that decade, use of services for behavioral health, which includes substance abuse and mental-health conditions, went up 320 percent. Treatment related to use and dependence on amphetamines climbed more than 3,000 percent, while use of treatment for anxiety diagnoses spiked more than 240 percent.

Coverage for such conditions is rising at a time when the United States is undergoing a major crisis in opioid addiction, which led to 47,600 overdose deaths last year. President Trump signed a sweeping bipartisan opioids package in October and has set up a task force to target drug manufacturers and distributors for their role in the epidemic.

Since the passage of two key laws making access to insurance easier, experts said they’ve seen a dramatic rise  in treatment claims from those with substance abuse and mental health conditions. The Mental Health Parity and Addiction Equity Act of 2008 largely mandated equal coverage for mental health and substance abuse services in the same way as medical and surgical procedures. Coverage was further expanded under the 2010 Affordable Care Act, which made behavioral health an “essential health benefit” requiring coverage by individual and small-group plans, too.

Mental-health experts are pleased with the developments. But some also caution there’s much more work to be done to meet the growing demand.

Broken down, FAIR Health found coverage for services related to amphetamines increased a whopping 3,157 percent. Meanwhile, claims for those seeking treatment for barbiturate use went up 2,233 percent; for hallucinogens went up 2,055 percent; and for cannabis increased 585 percent.

The increase isn't as obvious for coverage of mental-health conditions, but still there’s a clear uptick. The use of treatment for anxiety diagnoses increased 242 percent, for post-traumatic stress disorder went up 177 percent, for major depressive disorder went up 172 percent and for bipolar disorder increased 103 percent in the 10-year period.

FAIR Health president Robin Gelburd said the largest spike overall in the use of behavioral health services occurred between 2010 and 2011, following passage of the 2010 law that expanded health coverage to millions of Americans:

“It almost suggests there was a need that had been unmet until such time that people were getting proper coverage,” Gelburd said in an interview, adding the data suggests “clearly there is a before and after of utilization that would suggest people recognize they had the ability to plan for and cover expenses they may not have been able to before.”

She added: “At the same time, in terms of the volume of the increase, it at least should alert those within the health-care system to do a number of things.”

She said the report brings up questions about whether the “health-care delivery system is designed in a way to meet this growing need”: “Are there gaps that could be filled? Regulations or statutes that could be passed to render it easier to gain access to that care?”

Dr. Patrice A. Harris, president-elect of the American Medical Association, said those gaps definitely exist.

Harris said that, as a psychiatrist, she practiced “pre-Parity and post-Parity," referring to the 2008 law.

“Although certainly there have been some improvements — and you have to realize where we were starting from — we are long overdue for making sure that the Parity Act fulfills its full promise in ending discriminatory and illegal barriers to treatment,” she said.

Harris said the AMA has worked with state insurance commissioners and found “parity violations have continued despite state and federal laws.”

Ellen Weber, vice president of health initiatives at the nonprofit Legal Action Center, said there's a critical need to improve consumer education about benefits.

“Consumers need to understand what their rights are,” she said in an interview. “Many of them do not understand that they have a right to non-discriminatory coverage. They also have to know what to do when their [insurance] carrier denies services. In many situations, consumers think their carrier is right. They don’t realize they have the right to challenge those decisions."

Weber said insurance companies have an important role to play in helping mitigate the opioid crisis.

“It’s important to realize the role insurance carriers have in addressing the epidemic,” she said. “Who really knows the level of services that haven’t been provided, the services that have been denied."

In a Stat op-ed they co-wrote last week, Weber and Harris cited a report from the Department of Health and Human Service’s Substance Abuse and Mental Health Services Administration that found of the “22 million Americans who need addiction treatment, only about 10 percent are getting it.”

“We are 10 years out, and so we should be much further along here,” Harris said.

AHH, OOF and OUCH

AHH: My Post colleague Robert Barnes zooms further in on the potential fate of the ACA if the controversial decision from U.S. District Judge Reed O’Connor makes its way to the Supreme Court.

If that happens, it will face the same majority that has twice before upheld the health-care law and will probably “hinge on Chief Justice John G. Roberts Jr., the conservative who in the two previous cases wrote the opinions that dismissed the challenges,” Robert writes. “And this time, it would come without the galvanized support of the conservative legal establishment that has marked previous lawsuits and in a political climate in which even Republican lawmakers are more likely to talk about replacing Obamacare than destroying it.”

A path to the high court is long. The case would first be considered by the U.S. Court of Appeals for the 5th Circuit and would not come before the Supreme Court until the term starting next October.

Meanwhile, 16 Democratic-led states called on Judge O’Connor to clarify his ruling to establish whether his decision has “any immediate legal effect” or whether the ACA is still law while the ruling is fought in court.

The Trump administration itself has made clear the ACA is still in effect. HHS issued a statement Monday saying it  “will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision.”

OOF: At least one state official is responding to the Friday ruling to strike down the ACA by vowing to take health coverage into his own hands.

Texas Gov. Greg Abbott (R) said the state will work on its own health-care law to replace the ACA if the law is ultimately struck down after the next series of legal maneuvers. 

"As the ACA lawsuit goes through the appellate process, Texas will work with the Administration to get appropriate waivers from federal law allowing insurers to provide coverage at lower rates while ensuring that Texans with pre-existing conditions continue to have access to quality healthcare," Abbott said, the Dallas Morning News’s Lauren McGaughy reports. "Additionally, Texas will begin the process of reforming state regulations and proposing changes to laws that will achieve those same goals. Importantly, Texas will strive to expand healthcare insurance coverage, reduce the cost of healthcare, and ensure that Texans with pre-existing conditions are protected."

OUCH: A new study found that for some students, a negative report card out on Friday means an increase in mistreatment over the weekend.

The study, published in JAMA Pediatrics, found child abuse increased fourfold on Saturday after report cards were distributed at Florida public schools on Fridays, based on an examination of reports called in to Florida Department of Children and Families abuse hotline and a focus on children ages 5 to 11, the New York Times’s Julia Jacobs reports.

The report also noted at 31 percent, Friday was the most popular day to release report cards.

“Melissa A. Bright, the lead author of the study, said the idea for the research arose from the personal accounts of pediatricians and teachers who saw a pattern of abuse shortly after report cards were released,” Julia writes. She describes how pediatricians studying abuse found for years, children would explain that report cards were the reason they were abused. And some parents explained they hit their children “because they got a C.”

“Researchers were surprised to find an association between verified reports of abuse and report cards only when the grades were released on a Friday,” Julia writes. “On weekdays, caregivers may have been too ‘distracted’ to punish their children, researchers speculated. Dr. Bright added that children might have been spared punishments on weekdays because they would be attending school the next day, and teachers are legally bound to report evidence of abuse. Alcohol use by caregivers on weekends might also have played a role, she added.”

HEALTH ON THE HILL

— Sen. Lamar Alexander (R-Tenn.) announced he won’t be seeking another term in 2020. The current chair of the Senate Health, Education, Labor and Pensions Committee, Alexander was at the center of an attempt to repeal and replace the ACA last year.

His departure also sets up a "fight for the gavel of that committee, which wages outsized influence on Washington’s health care agenda," Stat's Nicholas Florko reports. "Next in line for that position is Sen. Mike Enzi of Wyoming, who already chairs the powerful Senate Budget Committee and would have to relinquish that post to replace Alexander. Behind Enzi is Sen. Richard Burr of North Carolina."

Nicholas adds that Alexander, who received more than $365,000 from the drug industry since 2013, "has acted as a bulwark against some of the more sweeping, industry-opposed proposals that have been advanced by both his Republican and Democratic colleagues."

“The people of Tennessee have been very generous, electing me to serve more combined years as Governor and Senator than anyone else from our state,” Alexander said in a statement. “I am deeply grateful, but now it is time for someone else to have that privilege.”

Alexander’s decision will probably bring “a close to long political career characterized by his ability to work with politicians from both parties,” The Post’s John Wagner and Sean Sullivan write. “Alexander’s decision means that for the second time in two years, Tennessee will have an open U.S. Senate race.”

— Sen. Elizabeth Warren (D-Mass.) is releasing a bill Tuesday to establish a government-run drug manufacturer that produces generic drugs as a way to bring down prices.

“The bill, dubbed the Affordable Drug Manufacturing Act, is unlikely to pass the Republican-led Senate, but it signals that a future Warren White House could try to radically revamp the federal government’s role in the pharmaceutical market in order try to lower prices,” Politico’s Alex Thompson and Sarah Karlin-Smith report. Warren joins a slew of potential 2020 hopefuls who have introduced legislation aimed at the drug industry, including Sens. Jeff Merkley (D-Ore.), Kamala D. Harris (D-Calif.), Amy Klobuchar (D.-Minn.) and Sen. Bernie Sanders (I-Vt.).

“Drug companies use the ‘free market’ as a shield against any effort to reduce prices for families. But they’re not operating in a free market; they’re operating in a market that’s rigged to line their pockets and limit competition,” Warren writes in an op-ed in The Post. “The Affordable Drug Manufacturing Act would allow the Department of Health and Human Services to step in where the market has failed.”

“In the prescription drug market, the next step should be public manufacturing,” she writes, adding such a system “will be used to fix markets, not replace them.”

— Rep. Frank Pallone Jr. (D-N.J.), poised to lead the House Energy and Commerce Committee, says holding oversight hearings on the Trump administration’s involvement in the ACA lawsuit will be one of his main priorities.

"The problem is that the Republicans in the House, including the Republicans on my committee, have never had any serious oversight about what the Trump administration is doing to sabotage” the ACA, Pallone told reporters on a call, the Hill’s Jessie Hellman reports. “This sabotage, which takes form of inaction in the courts, action in the courts, regulations, all kinds of sneaky things. We don't know what they're doing. We will have hearings right away to get to the bottom of this and to see what they're doing and not doing."

Pallone also signaled Democrats in the House will move to vote on legislation that will allow them to intervene in the lawsuit, Jessie reports, as well as on measures to stabilize the ACA and bolster protections for people with preexisting illnesses.

"We're going to fight this decision tooth and nail in the courts and with the new Democratic majority in the House,” Pallone said on the call.

STATE SCAN

— Democratic Gov. Andrew M. Cuomo wants New York to be the next state with legalized pot.

Cuomo said he will push for a bill to legalize recreational use of marijuana in early 2019, a “move that could bring in more than $1.7 billion in sales annually and put New York in line with several neighboring states,” the New York Times’s Vivian Wang reports.

New York would join 10 states that have already legalized recreational marijuana, as well as the District of Columbia.

“The fact is we have had two criminal justice systems: one for the wealthy and the well off, and one for everyone else,” Cuomo said in a Monday speech outlining the agenda for the first 100 days of his new term. “Let’s legalize the adult use of recreational marijuana once and for all.”

“It follows a report issued in July by a state Department of Health commission that Mr. Cuomo had charged with studying the issue, after Massachusetts legalized recreational use in 2016 and as New Jersey moves to do the same,” Vivian writes.

“The commission concluded that the benefit of taxing and regulating the drug outweighed any potential negative effects. In addition to the tax revenue that marijuana sales would generate, legalizing marijuana could also ease the opioid crisis and mitigate racial disparities in the criminal justice system, the report said.”

— And here are a few more good reads from The Post and beyond: 

MEDICAL MISSIVES
National
Society and the government aren’t sure what to make of new techniques for animal breeding
Carolyn Y. Johnson, Christie Hemm Klok, Leo Ji and Karly Domb Sadof
With marijuana partially legalized in a growing number of states, advocates in Nebraska are pushing for their state to embrace medicinal cannabis.
New York Times
Some legal experts say contract law could provide consumers another avenue to challenge unexpected hospital bills.
Kaiser Health News
AGENCY ALERT
Fact Checker
Six of the most read fact checks were about President Trump, which should not be a surprise given how he dominates the news.
Glenn Kessler
Health care stocks have outperformed the broader market.
Axios
INDUSTRY RX
Johnson & Johnson on Monday scrambled to contain fallout from a Reuters report t...
Reuters
It’s a radical idea: On-demand insurance that lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use.
Associated Press
OPIOID OPTICS
Officers say exposure to opioids during emergencies can put them in mortal danger. Doctors say their symptoms may just be the “nocebo” effect.
The New York Times
DAYBOOK

Coming Up

  • The Senate and House Veterans Affairs committees hold a joint hearing on "Tracking Transformation: VA MISSION Act Implementation” on Wednesday.
  • The House Veterans Affairs Subcommittee on Oversight and Investigations holds a hearing on "The Veterans First Program after Kingdomware" on Thursday.
SUGAR RUSH

Will Trump supporters turn out in key states in 2020?