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ONE STEP FORWARD THREE STEPS BACK: Progress and peril for US mental health parity

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ONE STEP FORWARD, THREE STEPS BACK: PROGRESS AND PERIL FOR US MENTAL HEALTH PARITY

Dr. Benjamin F. Miller, President, Well Being Trust.

     

In the policy space, a space I spend a great deal of time in, when the right action or solution requires both input and action from Congress and the President of the United States, it often takes much, much more time than one might like. In the case of improving access to mental health care in our country, in the past week we’ve taken one step forward and three massive steps back.

Let’s start with the good news: President Biden has made massive investments in mental health during his first year in office, a boon to all those who have struggled through the pandemic and great encouragement to those who have spent much of their careers advocating for better mental health policies. This week, he took another step in the right direction by asking Congress to allocate more than $51.7 billion to strengthen behavioral health in his Fiscal Year 2023 budget.

If approved, the historic investment would go to improving youth mental health, boosting behavioral health workforce development, combating the opioid epidemic, and achieving other objectives from his Unity Agenda. Most notably, next year’s budget includes $125 million for federal regulators to enforce mental health parity laws.

Specifically, the White House calls out:

Expanded Coverage and Reduced Costs for Mental Health Services. For people with private health insurance, the Budget requires all health plans to cover mental health and substance use disorder benefits and ensures that plans have an adequate network of behavioral health providers. For Medicare, TRICARE, the VA healthcare system, health insurance issuers, group health plans, and the Federal Employees Health Benefit Program, the Budget lowers costs for mental health services for patients. The Budget also requires parity in coverage between mental health and substance use disorder (or behavioral health) and other medical benefits and expands the types of providers covered under Medicare to treat these conditions.

This is great news considering that the enforcement has been relatively lax over the years. And there’s a lot in the budget to like that I will be writing about in the future e.g. eliminating cost sharing for up to three mental health and primary care visits.

Now the bad: The release of Biden’s budget came just days after the 9th Circuit Court reversed a trial court’s ruling in the Wit v. United Behavioral Health case – allowing insurers the ability to use flawed medical necessity criteria to drastically limit patients’ access to mental health care.

This decision is a devastating blow to Americans who struggle to get access to vital mental health services. Legislators, advocates, and providers should be working with insurers to make it easier to afford care – to access care – not give up more power to the insurance industry to have free rein in denying their captive members medically necessary treatment.

The average cost of a traditional hour-long therapy session ranges from $65 to $250 for uninsured patients. Those that need medication, detoxification, and/or in-patient stays are looking at thousands of dollars in bills depending on the course of care. For the 1.1 million workers making the federal minimum wage of $7.25 per hour (or less), these costs would consume a vast majority of their pay check. Forcing patients and their families to decide between their mental health and having a roof over their head, food on their table, and gas in their car is absolutely abhorrent.

Yet countless families will have to make these decisions when it comes to seeking care all because of last week’s ruling and the historic failure to adequately enforce the Mental Health Parity and Addiction Equity Act (MHPAEA). Kaiser Family Foundation just released a study, sponsored in part by Well Being Trust, that revealed the top reasons for delaying - or skipping - mental health services were not knowing where to get help and the cost. These results prove what experts have long warned: payers are not doing enough to help patients have access to the care they need.

     

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Payers are sure to use the latest ruling to evade government accountability as well as their present - and pressing - responsibility to protect those who are held captive by their services. The consequences will be devastating and further drive the nation’s mental health crisis, resulting in countless deaths of despair. I cannot stress enough that payers must acknowledge their collective lack of action and immediately halt discriminatory practices. 

Congress has historically failed to enforce mental health parity laws, leaving patients to anguish at the hands of insurers who are driven by their bottom line alone. Without proper oversight and enforcement in place, the mental health system will continue to flounder under regulatory uncertainty and policies that exist as suggestions rather than as a rule. As the Biden Administration calls for action to better uphold these laws, only a united bipartisan front committed to enforcement measures will achieve an end goal that provides equal access to care.

Congress must also make meaningful investments in mental health policies as nearly one-third of U.S. adults with severe anxiety and/or depression do not receive care. With the introduction of Biden’s Unity Agenda and FY2023 budget, federal legislators have an opportunity to fund initiatives that ensure all Americans receive vital mental health services. From giving the money states need to see 988 succeed, to integrating services into community initiatives, to boosting the mental health workforce, Biden has outlined countless opportunities for Congress to invest.

They say good things come to those who wait. Personally, I believe good things come to those who take action. Despite some recent set backs for mental health, President Biden has laid out a solid plan to address the mental health crisis in our country, including how we cover care. And while the ongoing committee hearings on mental health are indeed promising direction, it remains on Congress to ensure the next step our nation takes is forward.

As President of Well Being Trust, Benjamin F. Miller, PsyD, oversees the implementation of the foundation’s strategies and full portfolio of investments and partnerships to help Well Being Trust have a real-world impact on America’s mental health and addiction crisis.

For more information on the Well Being Trust visit  https://wellbeingtrust.org/

Join UnitedGMH, Well Being Trust and a host of other partners for Mental Health Action Day on Thursday, May 19th when we will encourage and empower people to take the next step for #MentalHealthAction. Go to MentalHealthActionDay.org to learn more and join our effort to shift from awareness to action on mental health.