How White House hopes to boost mental, physical health parity

The U.S. departments of Labor, Treasury and Health and Human Services on Monday finalized a rule to ensure 175 million Americans who are covered by private insurance can afford the mental health and substance use treatment they need.
In a fact sheet posted on whitehouse.gov Monday, the Biden administration said it believes “health care is a right, not a privilege, and that mental health care is health care — period,” though the notice said it’s often hard to find and afford.
The rule will require health insurance companies to look at which mental health providers’ services are covered, how much the providers are paid, how often they require prior authorization for service and how often they deny claims for substance use treatment or mental health. Those must be comparable to benefits for physical health.
It’s not a new move. Mental health parity became a requirement in the 2008 Mental Health Parity and Addiction Equity Act, which was updated in 2020 by a bipartisan congressional vote to say that health plans that cover mental health and substance use care benefits do so at a level that’s equal to physical health care benefits.
The fact sheet quoted President Joe Biden: “There is no reason that breaking your arm should be treated differently than having a mental health condition.” He promised the measure would “dramatically expand access to mental health care in America.”
The release noted that in 2020, fewer than half of all adults with mental illness received treatment, while fewer than 70% of children seeking care for substance use or mental health were able to access such care. “That’s in part because insurers too often make it difficult to access mental health treatment, causing millions of consumers to have high out-of-pocket costs because they go out-of-network, or defer care altogether. One study shows that insured people are nearly four times as likely to go out-of-network and pay higher fees for mental health care than for physical health care. And the problem is getting worse: in recent years, the gap between usage of out-of-network care for mental health and substance use disorder benefits versus physical health benefits increased 85%,” per the White House.
Per the final rule:
The American Psychological Association issued a press release praising the final rules. “APA has always been a strong advocate for mental health parity, and since its enactment, APA has worked tirelessly to advocate for compliance with and enforcement of the federal parity law,” said Dr. Marketa M. Wills, APA CEO and medical director. “This is a big step forward to hold insurance plans accountable by ensuring the law’s intent is fulfilled and that more individuals will be able to access the mental health and substance use treatment they need.”
The association said the new measure codifies requirements in the Consolidated Appropriations Act of 2021 that insurers analyze the limitations on treatment coverage for mental health and substance use disorder and provide the data to regulators and plan beneficiaries on request. Under the new rules, “insurers will be expected to produce information on outcomes, such as claims denials, and to take actions to address material differences in access to care.”
The Hill reported that there’s no enforcement mechanisms, noting the belief that insurers will comply to stay competitive. But Neera Tanden, the head of Biden’s Domestic Policy Council, had previously told Politico that “while the administration hopes for a collaborative approach to enforcement ‘without the sticks,’ it will ‘fully enforce the parity law.’”
Per The Hill article, while mental health and substance use coverage has broad bipartisan support, “at least one top Republican objected.” The Hill quotes Rep. Virginia Foxx, R-N.C, saying, “For over a year, we’ve been telling the Biden-Harris administration that these rules will not work. They are too vague and burdensome; they overregulate instead of allowing health plans to build robust networks; and they will increase premiums for employees already facing high health care costs,” she said in a statement. “These rules do nothing to improve mental health care access and instead put paperwork over patients.”
Politico predicts “significant backlash from insurers, who have argued that they are being unfairly targeted.” Some critics worry that expanded networks could include less qualified providers. Some argue that lack of access is because of workforce shortages. And others, the article said, “have argued employers will reduce their mental health coverage due to the expanded requirements and potential associated costs.”
Others say the measure is needed to improve access. “It shouldn’t be harder for you to find a provider that can treat your eating disorder than it is to find a provider who can treat your ulcer,” said Lisa Gomez, assistance secretary in the U.S. Department of Labor, which regulates health plans used by corporations.
Some aspects of the new rules go into effect in 2025, while they will all be in place in 2026.