Last year, suicide remained the third leading cause of death among young people age 10 to 24—while 13% of high school girls and 6% of boys attempted suicide. Also in 2023, only about half of Americans who needed mental-health care were able to receive it.
It’s why the Biden-Harris administration announced a new final ruling on Monday that aims to make it easier for Americans to access mental health treatment.
“These numbers are simply unacceptable,” Domestic Policy Advisor Neera Tanden told reporters in a Friday media call about the final ruling. “Behind these statistics, of course, are real people who are struggling, and almost everyone knows someone—a family member, a friend, or colleague—struggling with mental health challenges.”
While we know that treatment works, she added, “too many Americans struggle” to get the care they need, as it’s so often not covered by their insurance.
Said President Joe Biden in a statement about the ruling: "Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach. Today, my Administration is taking action to address our nation’s mental health crisis by ensuring mental health coverage will be covered at the same level as other health care for Americans."
The passing of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) into law was an attempt to address the issue of health insurers making it difficult for consumers to access in-network mental health coverage.
But in the years since, Tanden said, insurers have been evading the mandate of the law, and it’s continued to be difficult for consumers to access that care. “Consumers are often forced to seek out-of-network care at significantly higher costs and pay out of pocket, or defer care altogether,” she noted, emphasizing that privately insured people with a mental health condition typically spend over $1,500 a year, out of pocket, to get the treatment they need.
Tanden referred to a study which found that insured people are nearly four times as likely to be forced to go out-of-network to pay high fees for mental health care than for physical care. “We need to ensure that Americans can get treated for mental health just like they can get treated for a broken bone or a heart condition, and the Biden-Harris administration is making sure this happens," she said.
Today’s newly announced requirements aim to stop the “industry evasion” of MHPAEA by strengthening it and enforcing it, she said, in order to help families get the same access to mental health and substance-use benefits as they do to those for their physical health.
The American Psychological Association is "optimistic" about the new rule, said APA chief of professional practice Jared L. Skillings in a statement. “Psychologists know that many Americans have faced unnecessary suffering because they have been unable to get timely or adequate care through their insurance. That’s why we have fought for so long for action," he said.
"It is vital that steps are taken to ensure that insurance networks include enough mental health practitioners to meet the needs of patients. The rule targets this network adequacy problem and recognizes that low pay for mental health providers is a major cause of network inadequacy."
Further, Skillings added, "While some insurance companies may claim network inadequacy is primarily due to a workforce shortage, we disagree. There is a large pool of experienced mental health providers ready to work with insurance companies if paid and treated fairly."
The final rules, which have taken into account feedback from both the public and departments that have been enforcing MHPAEA, will reinforce that health plans cannot unfairly restrict treatment by using what are known as non quantitative treatment limitations (NQTL)—meaning restrictions that are don’t have a numerical value, as with those that, for example, limit the number of times a patient may see a provider. Non-quantitative restrictions may require things like prior authorization for a treatment or that a patient try an inexpensive treatment option before a more expensive one will be covered. And under MHPAEA, all treatments must be offered in parity—meaning that the NQTLs (as well as all other types of restrictions) must be no more stringent for mental-health care than they are for medical/surgical care.
The ways insurers restrict patients from receiving needed care are part of why so many therapists do not accept insurance—with other reasons including low reimbursement rates and administrative hassle. The new rules hope to address those issues.
Assistant Secretary of Employee Benefits Security at the Department of Labor Lisa Gomez, also on the media call, explained that the new rules “knock down barriers to mental health and substance-use disorder benefits” by ensuring health-plan access that is equivalent to medical and surgical benefits. MPEA was supposed to have done that, Gomez said. The fact that it hasn’t been able to, she said, “is not fair, it’s not right, and it’s against the law.”
She added, “It shouldn't be harder for you to get care when you feel depressed than getting care when you have back pain.”
