Sep 20, 2022 - Health

Push for mental health parity hits turbulence

Illustration of a brain fastened in a seatbelt.

Illustration: Aïda Amer/Axios

Senators eager to address mental health care this year are encountering stiff headwinds in a bid to ensure parity, the idea that health insurers cover behavioral health and substance abuse at the same level as physical health.

Why it matters: Advocates for decades have charged that insurers are not adequately covering behavioral health services. The issue has become a priority for more lawmakers as the aftereffects of the pandemic become clear.

Driving the news: The Senate Finance Committee announced five bipartisan mental health "focus areas" in February, including insurance coverage.

  • The panel released discussion drafts on two of the less controversial areas, on telehealth and youth mental health. But enforcing "parity" in insurance coverage is prompting resistance from insurer and employer groups.
  • One sticking point is proposed financial penalties on insurers that violate parity requirements that are already written into law. A Senate GOP aide said Republicans have "jurisdictional concerns" because the Senate HELP Committee shares jurisdiction with Finance.
  • Parity "would probably [be] the last to wrap up" of the five areas, the aide said.

Between the lines: Under a 2008 law, insurers are supposed to ensure equal coverage between physical and mental health. But several federal reports have concluded that's not happening.

  • The Labor Department found this year that "health insurance issuers are failing to deliver parity for mental health and substance-use disorder benefits to those they cover."
  • "For example, a health insurance issuer covered nutritional counseling for medical conditions like diabetes, but not for mental health conditions such as anorexia nervosa, bulimia nervosa and binge-eating disorder," the department said.

Be smart: If insurers have to cover more mental health care, premiums and costs could rise. The prospect of passing that on to workers could be particularly tough for corporations in a tight labor market.

What they're saying: Asked about insurer lobbying on parity, Senate Finance Chairman Ron Wyden (D-Ore.) told Axios, "What's new?"

"[Insurance companies] always say they are doing a phenomenal job," Wyden said. "Everybody's fine, they're doing a great job and we should just appreciate them."

  • America's Health Insurance Plans last month issued its own roadmap for parity and have noted the recent "surprise billing" law strengthened existing federal oversight.
  • Employers have objected to some of the parity proposals that are in play.
  • One employer group wrote to lawmakers earlier this year that the real problem is "shortages of mental health care providers and mental health care providers who are unwilling to enter our networks."

What's next: Mental health legislation could be included in an anticipated year-end omnibus spending deal but is not likely to be ready in time to be rolled into a short term funding bill that's due this month to keep the government open.

  • "I think everything's pushed to the omni[bus]," Sen. Richard Burr (R-N.C.), who is leading the parity focus area for Republicans, told Axios of mental health efforts in general. "I'm involved in trying to get mental health legislation, but it's not going to happen in the CR."

The bottom line: Despite the resistance, Wyden says he's continuing to spotlight parity, pointing to early efforts from the late former Sens. Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.).

  • "A ghost network is what it sounds like: There aren't any providers, there's nobody to navigate you to one, and if you do get a claim, you might get a few bucks on it," Wyden said.
  • Sen. Michael Bennet (D-Colo.), who is chairing the parity focus area for Democrats, said in a statement he was committed to finding a legislative path in Congress.
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