Insurance Mergers Could Diminish Competition, Access to MH Care

The proposed mergers of four giant health insurance companies—forming Anthem-Cigna and Aetna-Humana—will eliminate consumer choice and encourage insurers to raise prices; they are also likely to have an especially dire effect on access to psychiatric care.

That’s what APA President Renée Binder, M.D., and CEO and Medical Director Saul Levin, M.D., M.P.A., told U.S. Assistant Attorney General William J. Baer, in a letter last month expressing APA’s grave concerns about the proposed mergers.

“APA agrees with the American Medical Association, the American Hospital Association, and the American Academy of Family Physicians and shares their concern that these proposed consolidations will functionally leave the vast majority of health care administration in the United States to three major insurers, thereby eliminating consumer choice and encouraging insurers to raise prices and reduce quality of care in most markets,” they wrote. “Furthermore, individuals with mental illness, including substance use disorders, are uniquely affected by the impact these mergers will have on access to psychiatric care in insurance plan provider networks. We request that the Department of Justice [DOJ] focus attention in its review of the proposed mergers on each company’s history of restricting access to clinically appropriate psychiatric care, as well as their ability to more severely restrict access to care if such acquisitions are permitted.”

In addition, Binder and Levin noted that seven years after passage of the Mental Health Parity and Addiction Equity Act, insurance companies have continued to use a variety of strategies to restrict access to psychiatric care, and that the proposed mergers would likely make it easier for them to do so.

They urged the DOJ, state insurance commissioners, state attorneys general, and Congress to take the following actions:

• Look into the merging parties’ treatment of patients with mental illness, including substance use disorders, and critically evaluate the adequacy of the networks by demanding data on claims filed by each psychiatrist listed in the directory.

• Gather claims data on out-of-network versus in-network claims paid for mental health care as compared with other types of health care.

• Compare the denial rates between mental health and other health claims.

• Explore the basis for discriminatory rates paid to psychiatrists versus other physicians for the same CPT codes and associated impacts on access to care.

• Explore the guideline-setting process, instructions, and payment models used by the companies with reviewers.

“After a thorough investigation of existing practices,” they concluded, “we are confident the relevant authorities will be convinced that the merged entities would be a threat not only to consumer choice and pricing, but also to consumer mental health and well-being.”

The proposed mergers of Anthem-Cigna and Aetna-Humana were the special focus of the AMA’s annual analysis of the health insurance market, Competition in Health Insurance: A Comprehensive Study of U.S. Markets.

The two mergers would diminish competition in up to 154 metropolitan areas within 23 states, according to the AMA. The report is based on 2013 data captured from commercial enrollment in fully and self-insured plans and includes participation in consumer-driven health plans.

“A lack of competition in health insurer markets is not in the best interests of patients or physicians,” said AMA President Steven J. Stack, M.D., in a statement accompanying the market analysis. “If a health insurer merger is likely to erode competition, employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care. Given these factors, AMA is urging federal and state regulators to carefully review the proposed mergers and use enforcement tools to preserve competition.” ■