“There is no reason that breaking your arm should be treated differently than having a mental health condition,” President Biden said in an official White House statement released this morning, September 9.
This, of course, isn’t a new sentiment, which is why we currently have the Mental Health Parity and Addiction Equity Act (MHPAEA), a federal law that works to prevent insurance companies from discriminating against mental-health conditions and substance-use disorders. While it was passed by congress in 2008 and “strengthened” in 2020, according to the White House, it hasn’t been very effective at creating equality between physical and mental health.
The current state of healthcare
The White House cites a study that shows people are four times more likely to go out of network for mental healthcare than they are for physical healthcare, demonstrating that whatever insurance companies are offering is just not cutting it. So, the goal of the new rules is to get insurers to follow the law—and also expand the reach of the law.
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According to the statement, insurers will now be required to submit to audits and reviews to ensure parity between mental and physical healthcare. It also puts a stop to “medical management techniques” (like pre-authorization requirements and limited provider networks) that can make it harder for people to get care. And while the the MHPAEA applies to private health insurers and federal insurance plans, part of the new rules includes expanding the reach of the MHPAEA to non-federal government-provided insurance plans, like plans for state workers.
If you’re yassing along to all of this, we’re with you. As President Biden said in the statement, “mental healthcare is healthcare,” and insurance companies had better get on board with that reality. However, like all executive branch statements, it’s unclear how big of an impact the rules will actually have.
What this really means
Currently, it’s unclear where these rules will actually live, or if they fall under the umbrella of an executive order (executive orders are notoriously difficult to enforce, since they don’t pass any laws; they merely instruct a government agency to do something). The announcement also does not state whether there will be a timeframe for when insurers will have to conduct these audits and make changes to bring their policies into compliance, nor does it outline an enforcement mechanism.
There’s also the question of whether or not the federal government is even the correct legislator or enforcer here. According to the Kaiser Family Foundation, states have traditionally played the biggest role in regulating health insurers.
Bigger picture: Getting insurers to cover mental healthcare is just one piece of the puzzle. Providers also need to choose to accept insurance or be in-network with insurers. And for providers to be incentivized to do that, insurance companies will need to make it financially worth their while. Because as long as the price of mental healthcare stays astronomically high (with costs averaging between $175 to $650 per 45-minute session in areas like New York City), it will continually be in the best interest of a provider to be paid directly out of pocket by their clients, rather than get reimbursed by insurance at a lower rate.
Can these new rules get insurers to actually stand behind the idea that “mental healthcare is healthcare”? It’s too soon to tell.
Well+Good has reached out to the White House for comment and will update this article with more information.
