The ink had scarcely dried on new federal rules for enforcement of the Mental Health Parity and Addiction Equity Act of 2008 when U.S. health plans threatened potential legal action to block them.
Buoyed by a recent Supreme Court ruling that shifts power away from federal agencies, health plans apparently hope to keep the departments of Labor, Treasury, and Health and Human Services from making parity a reality, years after Congress passed the law with resounding bipartisan support.
In crafting the new rules, agencies took scrupulous care to consider all points of view during a 13-month comment period, listening to patients, families, health care providers, employers, mental health advocates and the insurance companies themselves. Well over 95% of all stakeholders voiced support for the rules. Still, the agencies took opponents’ concerns seriously, withdrawing a proposal that insurance companies strenuously opposed.
Now the insurers are back, threatening action in the courts — and passing up a golden opportunity to heal their own discriminatory practices after years of delay and denial.
As written, the rules directly support the law’s intent by requiring health plans to compare the way they cover mental and physical health, seeking out “material differences” and taking “reasonable action” to resolve them. Any health plan that offers “meaningful benefits” for physical health would be required to do the same for mental health.
Since health plans have until Jan. 1, 2026, before key parts of the rules take effect, there is also ample time for them to come into compliance (a consideration they have been given time and again).
Threats of legal action, then, don’t reflect quibbles over the rulemaking process or objections to a rushed implementation process. Insurers are signaling their flat rejection of mental health parity.
This helps explain 16 long years of noncompliance with the Parity Act, during which health plans paid lip service to mental health while depriving millions of people of essential, often lifesaving care. It also explains why health plans have squeezed mental health and substance use providers with unfairly low reimbursements and endless administrative games that have pushed thousands not to accept insurance.
Stubborn opposition to mental health parity proves that health plans are not in our corner, despite the hollow promises we hear every fall at enrollment time. What is even harder to fathom is that, in rejecting parity, insurers are blocking billions in potential cost savings that clearly would serve their own financial interests.
When researchers at the consulting firm Milliman conducted an independent review of data gathered from the insurers themselves, they found that people with mental health or substance use conditions had physical health care costs that were 2.8 to 6.2 times higher, yet half received almost no treatment for these conditions.
Treating mental and physical health on par would save commercial insurers between $19 billion and $38 billion each year, Milliman found. But, having separated mental health and physical health in hermetic corporate silos, health plans seem determined to chase short-term profits on the mental health side by delaying and denying valid, well-documented claims — often clawing back payments months or years after services are rendered.
Meanwhile, their own beneficiaries grow sicker without the care they need or bankrupt themselves trying to pay for it.
In light of these struggles — and proof that our underpaid, overtaxed mental health workforce may soon reach a breaking point — the new federal rules are a crucial step in the decades-long fight for parity. The new rules will make it easier for people to find mental health providers in their plan’s network and reduce the number of denials of care they get from their insurers. That means less time patients have to spend fighting on the phone and filing paperwork and more time they can spend on actual treatment and recovery.
If insurers file suit to block them, it will prove that they are more deeply committed to the dysfunctional status quo than the progress demanded by lawmakers on both sides of the aisle, both in 2008 and now. But there is still room for a dramatically different outcome.
Insurers have the power to heal the discriminatory practices that have harmed millions. Embracing — or even simply accepting — the rules will align them with the biological truth that mental and physical health are inseparable. This is why parity saves money and serves the interests of all stakeholders, insurers included.
David Lloyd is chief policy officer of Inseparable, a nonprofit organization devoted to achieving federal and state policy wins that advance the mental health of all Americans.