Problem Gamblers Face Institutional Bias In MI Over Health Care Coverage

Written By Drew Ellis on March 22, 2024
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The challenges for an individual struggling with problem gambling go beyond just the problem itself. Those with a gambling problem find themselves facing a greater difficulty getting health care than others with other dependency issues.

During the 16th Annual Michigan Problem Gambling Symposium last week, University of Oklahoma Law Professor Stacey A. Tovino discussed the institutional bias that those with a gambling problem face.

“Individuals who have gambling disorder have not been treated as well by the public health care programs and by private health plans, when you compare them to any other individual with any other physical or mental health condition,” Tovino said.

With March being Problem Gambling Awareness Month, it’s worth knowing the uphill battle those with a gambling problem have had to face when seeking help.

Bias against those with a gambling disorder from health insurance providers

A photo of Stacey Tovino, law professor at the University of Oklahoma
Stacey Tovino

One of the biggest areas where Tovino has seen bias against those suffering from gambling disorder is with health insurance coverage and policies.

Issues those with a gambling disorder routinely face in health insurance are:

  • Limited or no coverage on policies
  • Lower annual spending caps
  • Lower lifetime spending caps
  • Fewer covered outpatient visits
  • Higher deductibles
  • Higher co-pay amounts
  • Higher co-insurance amounts
  • More stringent medical necessity requirements
  • More pre-authorization requirements

These limitations or adjustments aren’t typically applied for physical ailments.

“If you’re an individual with gambling disorder and cognitive behavioral therapy will be helpful to you, you might be given a much lower number of insurance-covered inpatient days or outpatient visits compared to the individual who has a physical health condition,” Tovino said.

In some instances, insurance companies have gone out of their way to exclude any coverage of gambling dependency despite treating alcohol or substance abuse.

Problem gambling has been associated with the label of “impulse control disorders,” which insurance companies typically do not cover.

As online gambling continues to expand throughout the country, Tovino said that insurance companies are going even more out of their way to avoid providing gambling disorder coverage.

“Now we are seeing health insurance policies that are specifically not providing protection for online gambling disorder. It’s really the opposite (of what should be happening). It’s quite frustrating.”

A history of mental health and addiction law

Starting in 1996, efforts were made to adjust laws to better provide coverage for mental health services and addiction.

Mental Health Parity Act of 1996

This was signed into law by President Bill Clinton. In this law it was said that if part of a large health group plan of 51 or more employees, and you voluntarily offer mental health benefits, you can’t lower lifetime spending caps or annual spending caps on offered mental health benefits.

However, the law still left it up to the health insurance providers on whether they wanted to include mental health benefits in their plan in the first place.

Insurers could have simply elected not to include them, as the law didn’t force them to. The law also allowed insurance companies to exclude addiction disorders from mental health benefits.

This law also didn’t apply to individual or small-group insurance plans, only large-group plans.

Paul Wellstone and Pete Domenci Mental Health Parity and Addiction Equity Act of 2008

This mouthful of a law was signed by President George W. Bush. This law was aimed at improving the initial law that was passed in 1996 by Clinton.

In this updated law, addiction disorders were included in mental health benefits package.

However, it was still on a volunteer basis from the insurance providers and still just for large-group plans.

Patient Protection and Affordable Care Act of 2010

President Barack Obama signed this into law.

This latest law removed the large-group health plan requirement for mental health coverage. That allowed it to be included in small-group plans or individual plans.

The new law also established an Essential Health Benefits Provision. That required 10 sets of essential benefits to be included in plans that certain health insurance providers had to meet.

Included among those essential benefits was mental health and substance use disorder services, which includes behavioral health treatments.

However, the law didn’t apply to all health insurance policies. It was mandatory for individual and small-group plans. However, large-group plans still didn’t have to comply and could offer services on a volunteer basis.

“Many that get their health insurance through their job in a large-group plan, they will not have a legal right to gambling disorder treatments,” Tovino said.

States left to decide what are essential benefits

Right after the Affordable Care Act was signed into law, each state was told to select something called a ‘benchmark health plan.’

The benchmark health plan in each state is a health insurance policy that all the other individual and small-group health policies had to meet.

If a state’s benchmark plan contained gambling disorder treatments, then those health plans would have to include services for gambling disorder.

Few states contain language in their benchmark plans to specifically include gambling disorder.

Michigan doesn’t have a plan that specifically includes or excludes gambling disorder. That means health insurance policies aren’t legally entitled to cover gambling disorder as part of the essential health benefits.

Problem gambling not considered a disability

Adding to the difficulty of getting treatment is that gambling disorder isn’t recognized by many as a mental health issue. It also isn’t taken as serious a dependency as alcohol or substance addiction.

The Americans with Disabilities Act doesn’t include compulsive gambling as a disability, but do consider alcohol and substance abuse as a disability. Instead, gambling addiction gets labeled alongside kleptomania and pyromania.

Because of that, many in the health insurance industry view it as a “non-chemical addiction,” giving them the power to elect not to provide coverage or see it as an essential benefit.

It also gives employers the legal power to discriminate against those with a gambling dependency.

An individual with alcohol use disorder is considered an individual with a disability. Employers could be required to accommodate their needs, like attending AA meetings during work.

However, since gambling disorder is not considered a disability, employers do not have to accommodate their treatment needs at the workplace.

Michigan’s responsible gambling programs

There are several excellent options for responsible gambling or responsible gaming programs in Michigan.

Don’t Regret The Bet Program, from the Michigan Gaming Control Board

In May of 2023, the State of Michigan, under leadership from the Michigan Gaming Control Board (MGCB), launched a new website called Don’t Regret The Bet. The new website has resources, tips, and even a quiz for people to learn if they have a gambling addiction.

Michigan offers a Responsible Gambling Hotline at 1-888-223-3044.

Michigan Department of Health and Human Services helpline on Problem Gambling

The Michigan Department of Health and Human Services’ problem gambling helpline is a toll-free, confidential, one-on-one helpline that offers help and support for Michigan residents who are problem gamblers and gambling addicts.

The phone number is 1-800-270-7117.

Casino or Sportsbook Self-Exclusion

By law, online and physical casinos must provide a mechanism so consumers can exclude themselves from being able to place bets. The self-exclusion allows anyone to place their name on a list for a fixed time or permanently. As a result, they cannot enter the casino, or place a wager at an online casino or sports betting site. Michigan also allows any consumer to take a break from betting, for weeks, or even months.

Gamblers Anonymous

Gamblers Anonymous, like its sister program Alcoholics Anonymous, provides a peer-to-peer 12-step program to address a problem. A link to the Gamblers Anonymous can be found on the Don’t Regret the Bet site, or from the MGCB.

National Council on Problem Gambling

This esteemed national gambling problem awareness organization has a myriad of resources for gamblers or friends and family of gamblers. The national organization also has a toll-free number, 1-800-GAMBLER, to assist in identifying emergency services.

Game-Anon

The Game-Anon program is for friends and family of people with a gambling addiction.

Photo by PlayMichigan
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Drew Ellis

Drew Ellis is currently the Lead Writer of PlayILottery.com. He was the former Lead Writer of PlayMichigan, the No. 1 source for online gambling news in Michigan. A lifelong resident of the state, Ellis has been working in various forms of media since 1998, including more than a decade in the sports betting industry prior to transitioning into US casino markets in 2020.

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