Biden aims to boost mental health coverage
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The Biden administration today is taking new steps to make insurers cover mental health on a par with physical health, rekindling a fight with health plans that say such requirements are unworkable amid a shortage of providers.
Why it matters: The coverage requirements mark the most significant action on mental health parity in a decade and address persistent complaints that insurers are dodging existing regulations.
The big picture: The United States is in the throes of a worsening mental health and substance use crisis. Even Americans with health insurance can find behavioral health treatment cost-prohibitive because many counselors and therapists opt out of insurance networks.
- Adults with private coverage who were treated for anxiety or depression in 2021 spent an average of $1,501 annually out of pocket on health costs — nearly twice as much as adults without mental health diagnoses, a KFF analysis found.
The latest: Most health insurers have been required under a 2008 law to keep mental health benefits at the same level as physical health benefits. But providers and even the Department of Labor say payers skirt the rules.
- The Labor Department is reiterating today in a rule that health plans must analyze their provider networks, prior authorization policies, and out-of-network payment rates and come into compliance with the law if they're falling short.
- That could include boosting payment rates and contracting with more providers if insurance networks are deemed too skimpy, senior administration officials said.
- The officials said the policy being laid out today offers some flexibility for health plans compared to an earlier proposal on how insurers measure the effects of prior authorization restrictions.
It also requires more than 200 non-federal governmental health plans, like those offered to state and local government employees to comply with the 2008 law for the first time. Most provisions of the new policy will go into effect at the beginning of next year.
Reality check: The new requirements won't change the fact that more than half of all Americans live in areas without enough mental health professionals to meet the need.
- Insurers said the new requirements, as proposed, would be unworkable and amount to a costly mandate.
- The ERISA Industry Committee, a trade group for large employers offering health benefits, warned last fall that the administration's effort could cause employers to stop covering behavioral health services altogether.
- But employers offer mental health benefits to attract and retain workers, and dropping that coverage could put companies in a less competitive position, senior administration officials said.
What we're watching: Insurers have already said that they believe the Biden administration doesn't have the authority to lay down the new requirements, raising the odds of a legal fight to freeze them before they take effect.
- The requirements also come in the final months of the Biden administration, and a future administration could opt to scrap or dial them back.
- Recent Supreme Court decisions that weakened federal agencies' regulatory discretion could give insurers an upper hand in court.
- Asked if the administration made any changes in response to the Supreme Court, officials said they're confident the rule hews to the law.
