The Biden administration on Monday announced it would finalize a highly anticipated proposal meant to force health insurers to cover mental health care on the same basis as physical health conditions.
It is the latest salvo in a long-running federal government effort to crack down on insurance plans skimping on treatment for conditions including anxiety, depression, and addiction.
Despite longstanding law requiring health insurers to cover mental health as comprehensively as physical health, many Americans — even those with health insurance — still face financial obstacles when seeking care.
“It’s simple: It shouldn’t be harder for you to get care when you feel depressed than getting care when you have back pain,” Lisa Gomez, the assistant secretary for employee benefits security at the U.S. Department of Labor, said at a press conference. “It shouldn’t be harder for you to find a provider that can treat your eating disorder than it is to find a provider that can treat your ulcer.”
The finalized regulation follows a proposal that the Health and Human Services, Labor, and Treasury departments first put forward last summer.
The administration said the new rules will compel insurers to act on analyses they were already required to conduct to ensure they were covering mental health conditions on par with others.
The rule prohibits plans from using more restrictive prior authorization for mental health than for physical health conditions. It also closes loopholes that exempted insurance plans sponsored by state and local governments from its requirements.
The administration’s new regulation, however, does not include any new enforcement mechanisms. Asked about measures that will force payers to obey the existing and new parity rules, one Biden administration official simply said that health insurers would offer comprehensive behavioral health benefits as a means of staying competitive.
It is hardly the first time that federal regulators have attempted to penalize insurers believed to be pinching pennies when it comes to mental health coverage.
Congress first passed the Mental Health Parity Act in 1996. It was largely superseded in 2008 by new legislation named for the first bill’s authors: the late Sens. Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.), and then updated again in 2020.
But Biden administration officials said some insurers still fail to comply.
More than 15 years after the second bill’s passage, “people living with mental health and substance use disorders continue to face greater barriers when seeking benefits for those conditions and disorders under their plan and coverage than when seeking benefits for medical and surgical conditions,” Gomez said. “That’s not fair, it’s not right, and it’s against the law.”
The Biden administration’s move to finalize the new regulation comes more than a year after it was first proposed. Typically, final rules take effect at least 60 days after they are announced.
While efforts to improve mental health parity generally enjoy bipartisan support, one top Republican issued a statement blasting Biden’s latest effort as a regulatory overreach that will have little impact on patients.
“For over a year, we’ve been telling the Biden-Harris administration that these rules will not work,” said Rep. Virginia Foxx (R-N.C.), the chair of the House Committee on Education and Labor. “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. These rules do nothing to improve mental health care access and instead put paperwork over patients.”
In statements, Biden and Vice President Kamala Harris, the Democratic presidential nominee, cast the action as part of a far broader effort to help Americans access mental health care.
“President Biden and I are committed to ensuring that every person in our country has the mental health care they need to thrive,” Harris said. “That is why we made the largest investment in youth mental health in history and are transforming how mental health is understood, perceived, and treated for all Americans. Today, we are building on this lifesaving and life-changing work by announcing the finalization of a historic rule that will expand mental health care across our nation so more of our loved ones, neighbors, coworkers, and classmates receive the care they deserve.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.