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A struggle over decades to force insurers to cover mental health and addiction services on the same basis as medical and surgical costs is headed for success under new rules issued on Friday by the Obama administration. The rules will cover most Americans with health insurance, including those in many employer-sponsored plans, in other group plans, in some but not all Medicaid plans, and in policies bought on the individual markets.
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The rules strengthen a 2008 law that required parity in coverage — but only when an insurer actually offered mental health and addiction benefits. It did not require such benefits. The new health care law, the Affordable Care Act, does require coverage for mental health and substance abuse as 1 of 10 essential benefits in any new health plans. Combined, the two complete the job of offering both parity and coverage.

What the new rule would mean in practice is that limits on the amount of co-payments and the number of doctor visits or hospital days cannot be less generous than those that apply to most medical and surgical benefits. The same would be true of other rules, like those requiring prior authorization.

The benefits for the American public could be substantial, bringing help to many people previously unable to get it because of the cost. About a quarter of Americans 18 and older have a diagnosable mental disorder in a given year, and 6 percent have a seriously debilitating disorder, according to the National Institute of Mental Health. Nearly 60 percent of the people with mental health conditions and 90 percent of those with substance abuse problems don’t get the treatment they need, according to the administration.

The administration hopes that making treatment available to the mentally ill will help reduce gun violence, including mass murders. Some backers of parity believe it will also help veterans suffering from stress disorders from the battlefield get easier access to mental health services.

The effect on costs is uncertain. Insurers fear that the expenses of high-cost inpatient treatment or long-term rehabilitation of patients suffering from mental health disorders or substance abuse will drive up insurance costs, but experts say the number of people receiving high levels of care will be too small to have a significant effect on overall costs. And in the long run, better care could cure enough people to save billions of dollars a year in medical costs, lost wages and reduced productivity associated with alcoholism and other addictions.