Bill Overview
Title: Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act
Description: This bill requires health insurance plans to define their coverage of mental health conditions and substance use disorder based on specified external benchmarks.
Sponsors: Rep. Moore, Gwen [D-WI-4]
Target Audience
Population: People with mental health and substance use disorder globally
Estimated Size: 70000000
- The bill affects individuals with mental health conditions.
- The bill impacts individuals dealing with substance use disorders.
- The bill affects people who have health insurance plans that cover these conditions.
- Mental health and substance use disorders are prevalent conditions worldwide.
Reasoning
- The policy has a targeted budget meant to support mental health and substance use disorder treatment through insurance coverage.
- Approximately 66 million Americans experience mental illness, with about 19 million also experiencing substance use disorders.
- The mental health and substance use disorder treatment coverage is crucial because these are prevalent conditions which might impact quality of life, employment, and societal costs.
- The policy effectively impacts those who have existing insurance but whose coverage might not be clear or comprehensive.
- Individuals with comprehensive existing coverage might see low or no impacts.
- Young adults, veterans, low-income groups, and individuals in states with varying health insurance laws might see differentiated impacts.
- Commonness among interviewees is considered to reflect the diversity and frequency of experiences across different sub-populations.
- Budget limitations require strategic implementation to ensure significant targeted impacts adhering to the specified financial constraints.
Simulated Interviews
Freelance Designer (New York, NY)
Age: 25 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I've always struggled with understanding what my insurance covers for therapy.
- If this policy simplifies that, it'll be amazing for my mental health management.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Software Engineer (Los Angeles, CA)
Age: 32 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- I hope this policy will make the rules clearer, so I don't worry about what is covered when I seek treatment.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Unemployed (Austin, TX)
Age: 40 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Public insurance often feels unpredictable; I never know if a new treatment will be covered.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Veteran (Miami, FL)
Age: 29 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- I hope this policy can integrate my veterans benefits more smoothly with civilian insurance.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Teacher (Chicago, IL)
Age: 45 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- I always fear sudden changes in what's covered by insurance, even if it's currently good.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Accountant (Phoenix, AZ)
Age: 38 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- A clearer policy could reduce my anxiety about seeking help at a financial risk.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Factory Worker (Detroit, MI)
Age: 54 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- It's always unclear what therapies are covered; anything to standardize that would help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Retired (Seattle, WA)
Age: 60 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- More straightforward policy terms would be beneficial, but I'm skeptical about actual changes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Waitstaff (Denver, CO)
Age: 27 | Gender: other
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 2/20
Statement of Opinion:
- Hopeful that this act could encourage my employer to offer better insurance plans.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 4 |
Self-employed (Atlanta, GA)
Age: 48 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- Limited coverage makes managing ADHD challenging, clear terms could make a huge difference.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Cost Estimates
Year 1: $1500000000 (Low: $1000000000, High: $2000000000)
Year 2: $1400000000 (Low: $900000000, High: $1900000000)
Year 3: $1300000000 (Low: $800000000, High: $1800000000)
Year 5: $1200000000 (Low: $750000000, High: $1700000000)
Year 10: $1100000000 (Low: $700000000, High: $1600000000)
Year 100: $500000000 (Low: $300000000, High: $700000000)
Key Considerations
- The bill’s requirement for external benchmarks may require extensive collaboration with mental health professionals and insurance providers to ensure accuracy and fairness.
- Administrative costs for insurance providers may be significant initially.
- Long-term savings could offset short-term costs due to improved treatment outcomes.