By JJ Conway
J.J. Conway Law
J.J. Conway Law
In marking our firm’s 25th anniversary, we were provided a special opportunity to look back at some of the important contributions made by our clients who changed the law in a meaningful way. Their cases have been impactful. From healthcare for children to pension security, the work of our clients is still making a difference in the lives of others to this day.
As we know, in law, we must always keep looking toward the horizon. And when we do, one of our clients who is working on improving the lives of others is Rachel Cuschieri-Murray.
Rachel has been at the forefront of passing a comprehensive mental health parity bill in Michigan. She and her husband became advocates in the children’s mental health community following a healthcare fight seeking mental health benefits for her son.
Rachel has organized advocacy groups, established a nationwide clearinghouse of information for parents seeking assistance with medical reimbursements, and is now working to bring a comprehensive mental health parity law to Michigan. Rachel’s thinking is ahead of the curve nationally and is needed in our state.
The federal Mental Health Parity and Addiction Equity Act was a bipartisan legislative achievement. The MHPAEA was based on solid public policy reasons and sought to improve upon an aspirational parity law passed earlier that didn’t really do much.
The bill’s two chief sponsors, Paul Wellstone, a Democratic Senator from Minnesota and Pete Domenici, a Republican Senator from New Mexico worked together to secure its passage. It was signed into law by President George W. Bush.
Both senators had personal family experiences with mental illness and mental health issues. They wisely recognized that mental illness and addiction is nonpartisan.
So, they crafted a law that sought to destigmatize mental illness and create a kind of “parity,” or equality, in the delivery of healthcare benefits.
The law and its regulations targeted such things as artificial treatment limitations, unfair cost-sharing obligations, and other barriers to care like onerous preauthorization requirements.
Following the law’s passage, plans could be required to show that coverage for mental health related issues was no more restrictive than for claims seeking medical or surgical treatments. The law’s scope was again expanded in 2010 under the Patient Protection and Affordable Healthcare Act which was signed into law by President Barack Obama.
While the law was a significant legislative achievement, health law and employee benefit practitioners quickly learned of its limits. For example, there is no private right of action to sue under the MHPAEA. There is no right to a jury trial. This is usually the product of lobbying efforts to water down a law’s strength. Also, there is no real relief beyond a traditional breach of contract remedy, so there is occasionally a duplicative aspect to mental health parity claims.
Oddly, the MHPAEA works best in a class action setting since entire coverage groups can be scrutinized and the limitations of widely issued policies can be better examined statistically for their impact on mental health coverage.
So it was that Rachel, in recognizing the disparity of care particularly for teens and adolescents in crisis, set about to change the law. She heard the stories from others about difficulties in securing care. She knew that insurers continued to play to stereotypes in this area.
Realizing just how much was at stake (the lives of children with mental health challenges) and how inadequate the state’s regulatory system is — an ineffectual insurance commissioner, a broken external medical review system, Rachel thought bigger. She and a number of advocates began working to create a mental health parity act for Michigan that would mean something. If her vision becomes reality, the disparities of care will be eliminated. The enforcement rights of those with such claims will be enhanced.
This is no small feat, and it is a game changer. Rachel and those working towards the law’s passage almost succeeded last year during the state’s legislative session.
News reports indicate that Michigan’s largest insurer set out to stop the legislation, and this last-minute push succeeded in blocking the bill.
To provide some cover, the state passed a duplicate mental health parity act which essentially mirrors the federal law. Passage of a more ambitious law awaits, but with Rachel Murray in the fight, the future looks bright for those who need it most.
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John Joseph (J.J.) Conway is an employee benefits and ERISA attorney and litigator and founder of J.J. Conway Law in Royal Oak.
