Also, new laws are needed to improve mental health and substance abuse care

To understand why the Biden Administration announced new laws last month to improve mental health care, look no further than ProPublica’s report on the issue in August.

Almost all Americans have health insurance, but health insurers are reducing such care for millions of consumers by paying mental health providers too little, forcing providers to leaving insurance networks, Maya Miller and Annie Waldman wrote for ProPublica. “Our report also documents how serious the consequences can be when patients do not receive medical or psychiatric treatment,” they added.

Pay more or pay for maintenance

Miller and Waldman worked with two other ProPublica reporters, Duaa Eldeib and Max Blau, to interview more than 500 mental health professionals, including psychologists and psychiatrists, many of whom who were fired from this job. The result: consumers with health insurance were forced to pay out of pocket or primary care, ProPublica reports in this article, “Why I Left the Internet.” NPR published a similar story on Aug. 25: “It can be hard to find a doctor who takes your insurance. Here’s why.”

Doctors told ProPublica that they have partnered with health insurance networks to reach patients in need of mental health care who cannot pay out of pocket. But even with that network, doctors faced an insurance system designed to undermine them, the reporters wrote. Although almost all Americans have health insurance, experts have found that almost half of consumers with mental illness cannot get treatment, ProPublica explained.

The new rules will make it easier for health insurers to comply with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which expanded on the Mental Health Parity Act of 1996, according to this report from the Milbank Quarterly. . Federal and state laws on mental health equity require insurers to provide the same access to mental health care that they provide to consumers who need medical care.

Despite such laws, health insurers often withhold coverage for mental health and delay or deny treatment, ProPublica explained. The reason: “These patients — whose problems can be chronic and expensive — are bad for business, industry insiders told ProPublica,” the reporters wrote.

Mental health stories to tell

For mental health journalists, consumer and patient angles will be especially important because many Americans have trouble finding professionals online. A related story is whether health insurers say they have enough mental health providers to meet the demand for such care.

As ProPublica has shown, insurers’ claims of having strong provider networks are often false. The biggest problem may be that the fees they pay doctors are too low and the barriers they put between doctors and patients are too high, ProPublica explained.

Another issue to watch out for is that employers will complain that the new laws will raise their health insurance costs, forcing them to forgo mental health care, as Sara Hansard reported Bloomberg Law in February.

Even before the Biden administration issued the new rules, consulting firm PwC predicted in July that employers will pay 8% more next year for medical care than they did this year. . The ERISA Industry Committee, a trade group for US employers with large health plans, says the new rules could make those costs higher, as Amina Niasse reported to Reuters.

The rules will affect 175 million Americans

These stories are important because the new regulations will affect employers who provide health insurance and mental health care to the 150 million Americans who have insurance through their employers and the more than 250,000 Americans who have health insurance in the individual market, according to the federal. Department of Labor. Not federal or state jobs, said Tim Clement, vice president of government affairs for Mental Health America, a nonprofit organization in Washington, DC, that advocates for policy and legislation to improve mental health care. MH.

Because of the high demand for mental health services and substance abuse, health insurers need to increase payment rates for doctors, said Tim Clement, vice president of information of the government Mental Health America, a non-profit organization in Washington, DC, that advocates for the policy. and legislation to improve MH care.

In the interview, Clement explained that the new rules will help state health regulators monitor insurance rates and their networks.

“Internet infrastructure is the main focus of the new laws,” he commented. He said that in some areas there may be enough doctors, but they may not be in the network because the network rates are too low.

To limit the limits of treatment

An important part of the new rules, Clement noted, is that it prevents insurers from having limits that limit mental health and substance use disorders more than they have for medical and surgical care. The law defines such restrictions as unlimited treatment limitations that limit the amount or duration of benefits, such as prior authorization requirements, step-by-step treatment and rates for adding in-network therapists, according to the statement. from three government agencies that are adding new content. , the departments of Health and Human Services, Labor and Treasury.

In announcing the new rules, the White House cited research showing that in 2019 nearly 21% of adults over the age of 18 had a mental illness, and 14.5% of people over the age of 11 had a problem using drugs. However, only 46.2% of adults received mental health care and only 6.5% of those with substance abuse problems received treatment.

In addition, the White House said that insurance customers are four times more likely to go out of network and pay more for mental health care than they are for physical care. , according to a survey that RTI International published in April. “And the problem is getting worse: in recent years, the gap between the use of outpatient care for mental health and the benefits of substance use versus the benefits of health of the body has increased by 85%,” the White House added.

Two years earlier, the government’s Government Accountability Office reported similar problems in this report, “Mental Care: Access Challenges for Covered Consumers and Good Government Efforts.” Consumers had trouble finding in-network therapists accepting new patients, the report said, adding that low payments to providers contributed to the problem and that some providers were paid more than outside the network of projects.

Some of the rules will go into effect on January 1, 2025, Clement said, but most of the requirements will go into effect on January 1, 2026.

Tools

• “Departments of Labor, Health and Human Services, Final Rules for Financial Disclosure Strengthening Mental Health, Substance Abuse Benefits,” Sept. 9, 2024.
• “Health Care Leaders Respond to Administrative Change in Mental Health Parity Act,” ERISA Industry Committee, September 9, 2024.
• “I Don’t Want to Die”: In Need of Mental Health Care, Trapped by Insurer’s Ghost Network,” ProPublica, Sept. 8, 2024.
• “Health Behavior Parity – Widespread Disparities in Online Care Experience Continue,” RTI International, 17 April 2024.
• “Factors Affecting State-Level Implementation of the Federal Mental Health Parity and Addiction Equity Act: A Case Study of Four States,” Journal of Health Politics, Policy and Law, Feb. 1, 2023.
• “Narrow Networks Are Stronger When Shopping for Mental Health Professionals,” KFF Health News, Sept. 22, 2017
• “Acceptance of Insurance by Psychiatrists and Outcomes of Seeking Mental Health Care,” JAMA Psychiatry, February 2014
• “The Political History of Federal Mental Health and Addiction Insurance Parity,” The Milbank Quarterly, September 2010.