The Biden administration is taking a hardline approach towards health insurers, accusing them of circumventing federal laws mandating equal access to mental health care. The administration has introduced new regulations aimed at ensuring compliance, accompanied by the threat of substantial fines for non-compliance. Insurers, however, maintain their innocence and have garnered support from major corporations, arguing that the administration’s plan may exacerbate the situation.
This confrontation emerges at a time when mental health care needs in the United States are surging to unprecedented levels, propelled by the enduring effects of the pandemic.
Neera Tanden, head of President Joe Biden’s domestic policy council, remarked, “We always hope for collaboration, but the rule has sticks as well.” She emphasized that while they anticipate insurers changing their behavior voluntarily, they are fully prepared to rigorously enforce the parity law.
The “sticks” mentioned by Tanden include imposing fines of $100 per policyholder per day if insurers do not address the alleged loopholes that the administration claims they are exploiting to restrict mental health care coverage. These tactics include requiring doctors to seek insurer approval before providing care, reducing reimbursement rates for mental health providers, and deliberately limiting the availability of in-network physicians for patients seeking mental health treatment.
Insurers contend that the Biden administration is unfairly targeting them and argue that they are already making significant efforts to enhance access to care through technology such as telehealth, expanding provider networks, and increasing payments to providers. They are also working on integrating mental health care into primary care settings.
Craig Smith, a partner at law firm Hogan Lovells and former general counsel for Florida’s Agency for Health Care Administration, stated, “Nobody has a magic wand to create the number of mental health providers to match the number of physical health providers.” He emphasized that while regulations and statutes can be enacted, they cannot instantly resolve the challenge of a shortage of qualified mental health care providers, which affects nearly half of the U.S. population, according to research by the Kaiser Family Foundation.
The White House, however, points to a 2022 report to Congress from multiple departments, which found that none of the 156 insurance plans and issuers examined were adhering to the rules that required them to assess their compliance with the 2008 mental health parity law.
Advocates of the Biden administration’s rules contend that the insurers’ actions are primarily driven by cost-saving measures, resulting in reduced reimbursement rates for mental health services.
Senator Chris Murphy (D-Conn.) summed it up, stating, “The insurers are cracking down on mental health reimbursement in order to save money.”
