Tucked in remarks the president made Tuesday on the opioid epidemic was his announcement of a new task force on mental health parity — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.
Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.
“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”
Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.
“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”
In a 2015 survey by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only a handful of states, including California and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as Kaiser Health News reportedlast year.
For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.
“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.
Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”
Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were the final parity rules for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).
Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.
“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”
The interagency task force, which will be chaired by the White House’s Domestic Policy Council, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.
“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.
People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”
Provider groups widely applauded the creation of the task force.
“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.
“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.
But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”
“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”
That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.
“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller said.