Unfortunately in the American health care system, just because a law is passed requiring that health insurance companies cover a treatment, service, or medication, that doesn’t mean it actually happens.

For instance, about 25% of people still pay for birth control even though the Affordable Care Act mandated that insurance companies make it free more than a decade ago. On the state level, insurers have denied diabetes supplies, reconstructive breast surgeries, emergency services, and other types of required care, according to ProPublica.

The problem comes down to enforcing the laws by holding insurers accountable. In its 2023 study of all 50 states, ProPublica “…identified just 45 enforcement actions since 2018 involving denials that have violated coverage mandates.” 

Because insurers rarely face material consequences for non-coverage, it often takes years of concerted effort to see real change. 

For mental health and substance use disorders, making substantive progress through better health insurance coverage has been years in the making — but a proposed new rule could potentially change the landscape.

What You Should Know Today About  Progress in Mental Health Coverage

For more than 15 years, mental health and substance use disorders (MH/SUDs) were supposed to be covered the same as other medical care, thanks to The Mental Health Parity Equity and Addiction Act, co-authored by Patrick J. Kennedy.

Because the law had large gaps in enforcement, anyone who has sought treatment for mental health conditions or substance use disorders could have experienced a potential health insurance coverage inequity personally, like:

• Limits on how many times you can access treatment 
• Mental health treatments or medicines that were denied coverage 
• Paying more (or out-of-pocket) for mental health medications or treatments

These are just a few of the barriers (and potential violations) that are in place when Americans try to access care. 

>>>Read Here: Everything Consumers Should Know About Being Denied Treatment

A lack of parity also affects quality of care. For instance, an estimated 45% of psychiatrists don’t take insurance because of time-intensive, complicated administrative processes or because they are under-reimbursed or paid late by insurers. Additionally, the list of mental health providers in your health insurance’s network may be short or insufficient. For instance, maybe you can’t find a counselor who focuses on certain issues, like PTSD, or who has experience with different backgrounds, like LGBTQ+ folks.

Will We Ever Get Mental Health Parity in America?

Organizations like The Kennedy Forum are dedicated to achieving mental health parity, but progress often comes in hard-won bits and pieces. The proposed new rule from the Biden-Harris administration is perhaps the strongest step we have seen in many years to enhance enforcement of mental health parity. 

The major impact of the new Parity rule would be that health insurance companies will be required to report to regulators, which would significantly improve transparency.

When insurers provide quantifiable data, it will more clearly show where disparities exist in a number of areas like:

• How much consumers pay for mental health/substance use disorder care vs. physical or surgical care
• The rate at which behavioral health providers are reimbursed — which can be much lower than other professionals in health care
• How often mental health treatments or medications are denied due to prior authorization or other utilization management techniques

Organizations like The Kennedy Forum employ a talented team of policy experts who will be tracking, analyzing, and making recommendations to lawmakers and decision-makers based on these numbers. It’s yet another step toward ensuring all Americans get the help they need how, where, and when they need it.

If you want to learn if insurance companies will comply with the new rule, sign up for our email newsletter, or follow us on LinkedIn.