While some states have passed addiction parity bills intended to equalize insurance coverage between addiction and mental-health disorders and other diseases, new research demonstrates that most workers still face stricter annual limits, lifetime caps, and cost-sharing when they try to access addiction treatment.

Researcher Jon Gabel of the National Opinion Research Center and colleagues found that in 2006, 88 percent of workers with employer-provided health insurance had some coverage for addiction problems, but only 19 percent had plans that offered unlimited office visits and hospital stays, as is typical in other areas of health care.

Gabel and colleagues estimated that deductibles for addiction services averaged 46 percent higher than those for medical and surgical conditions. Moreover, 40 percent of employees were required to pay coinsurance for addictive disorders, compared to 12 percent for other medical conditions.

"People who try to get care for substance abuse but aren't successful most often say that cost is the reason," said Gabel. "Substance abuse is a treatable chronic medical condition, similar to diabetes or heart disease, and the economic costs of not treating substance abuse can be many times the costs of treatment. Yet the higher cost sharing for substance abuse problems that many workers face can discourage them from seeking treatment. In addition, limitations on inpatient days and outpatient visits, as well the failure to limit out-of-pocket costs, can discourage the long-term treatment and follow-up that substance abuse, like any chronic disease, often demands."

A second study found that many workers are exempt from state parity laws, and that only one in five benefited from strong laws mandating equal coverage for addiction services. Researcher Thomas Buchmueller of the University of Michigan's Ross School of Business said that while most states have passed parity laws in the past decade, they have been limited by loopholes, especially the ERISA exemption for self-insured firms and language in the parity legislation that allows small employers to dodge the requirements.

Researchers found that only 3 percent of workers were covered by parity laws that require equal coverage for all mental illnesses, 3.6 percent were protected by parity laws for alcohol problems, and 5.2 percent were covered by parity laws for drug-abuse disorders.

"States can improve the reach of their parity laws somewhat by extending them to small firms and all mental illnesses, as well as alcohol and drug abuse," said Buchmueller. "But the major limitation on these statutes is ERISA, and that's a federal law that states are powerless to change. So if parity requirements are going to be extended in a significant way, Congress and the president will have to step up and change the law."

Both studies appeared online June 7, 2007 in the journal Health Affairs.

Editor's Note: Learn more about equal treatment coverage and how you can help end discrimination against people with alcohol and drug problems.