Rebecca Bagley, who was named Chief Executive Officer of The Kennedy Forum in April 2022, recently promoted David Lloyd to Chief Policy Officer in recognition of his tremendous efforts to advance legislative priorities of the nonprofit.
With David at the helm of a growing policy team, The Forum is now poised to extend its reach across the country, helping advocates, policymakers, business leaders, and government agencies understand and act on mental health as a critical component of well-being.
In addition to being an expert on a range of mental health policy issues, including insurance coverage and the Mental Health Parity and Addiction Equity Act of 2008, David, who previously served as a Legislative Assistant to U.S. Senator Debbie Stabenow, has led many successful state and federal policy initiatives. His work, which includes enactment of powerful insurance legislation in California and more, has increased access to mental health and addiction care for millions of Americans.
Below is a special Q&A with David Lloyd, in celebration of his new role.
You focus a lot on policy efforts designed to bolster the 2008 Federal Parity Act, which Patrick J. Kennedy co-authored during his time in Congress. In your opinion, what are the greatest remaining challenges around parity?
A: The biggest challenge continues to be lack of enforcement. Though federal regulators have been increasingly aggressive in enforcing parity, the U.S. Department of Labor still lacks a very important tool: the ability to issue penalties for violations (i.e., make plans take parity seriously).
States also have a vital role to play in enforcing parity in individual and small group plans, as well as in Medicaid managed care. Yet, while we’re seeing more state regulators interested in parity, only about one in five states have ever penalized violations. Sustained, proactive oversight is needed to end discrimination in mental health and addiction coverage, and we’re just really beginning to see such oversight occur.
More broadly, tens of millions of Americans have no parity protections whatsoever. Medicare and traditional Medicaid aren’t subject to the Federal Parity Act—and neither is TRICARE for members of our armed forces and their families. Parity protections shouldn’t just be for a subset of Americans. Everyone deserves to receive equal coverage of mental health and addiction treatment services.
What’s it like working with partners across the nation to advance state-based parity bills? Any important lessons you’ve learned there?
Advocates in states are doing tremendous work. Their dedication is really inspiring, yet their work too often doesn’t receive the attention it deserves. I’ve been honored to collaborate with many state partners through The Kennedy Form’s State Parity Workgroup, which shares information and best practices on advancing parity at the state level.
One important lesson I’ve learned is that no two states are the same. There are different legislative procedures, traditions, and timelines around the country. Yet, there are also commonalities. One is how critically important stories and personal connections are. Parity can be a “wonky” issue, so you have to be able to break down how it really affects people. I’ve been heartened to see tremendous bipartisan support nationwide for increasing access to mental health and addiction treatment services. It’s because everyone is affected by these issues in one way or another, either personally or through a friend or family member. There is also near-universal support for the belief that mental health coverage should be no different than physical health coverage. We have made a ton of progress there. People are finally recognizing that mental health is inseparable from physical health.
What insights have you gained working alongside former Congressman Patrick J. Kennedy?
Congressman Kennedy is truly a visionary and is often a step or two ahead of everyone else, including me. He has the ability to see where we need to go and to issue clear calls to action that cut through the noise in ways few others can.
He has certainly helped me to see that, while policy details are important, to be successful we have to make it crystal clear that there are problems with our current system and show people that change is necessary. If you have a vision for where we need to go, you can then fill in the details of how to get from point A to point B.
When you look at the overall landscape in mental health care, what gives you hope?
These days, young people give me enormous hope. They talk about mental health in a way that even my generation (one of the first Millennials) did not. If we can’t have open and honest conversations about mental health, policy change is enormously difficult. More and more, we’re opening up the space for policy change.
Due to these cultural shifts and the undeniable impact of mental health and substance use disorders on our society, we’re now seeing more bipartisan support for policy change. That definitely gives me hope. We still have a long way to go, especially in the wake of the pandemic, but increasingly policymakers understand the types of reforms that are actually needed.
Where do you think we’ll be policy-wise in the next 5 years?
On health coverage, I think we’ll continue to make progress and many of the counterproductive coverage limitations—both in terms of human and financial costs—will be significantly lessened. Parity compliance will become more and more standardized. I also sincerely hope that we have in place strong standards for network adequacy and how plans make coverage determinations.
Reforming our mental health systems, though, will be a long-term process. And it is impossible to separate mental health from the inadequacies of the U.S. health care delivery and insurance system. If you don’t have health insurance, parity rules for your non-existent coverage don’t matter. And so much of what drives poor outcomes isn’t our health system at all, but rather the social determinants of health – or, as we think they should perhaps more appropriate be called, the “political” determinants of health. We have a long to go in addressing those, but to improve mental health and reduce substance use requires strengthening social connections, ensuring housing and access to transportation, decreasing environmental degredation, tackling climate change, and finally addressing numerous structural inequities in our society that limit opportunities. Black, Latino, Asian, Indigenous, LGBTQ+ and other communities must be at the forefront of identifying and driving forward needed change.
Obviously for policy experts, advocacy comes naturally, but what’s the best thing laypeople and families out there can do to get more involved and spark change?
Most importantly, people need to vote—and we must aggressively fight efforts to limit the right to vote. Beyond voting, it’s important to engage your local elected officials. Many of the most critical decisions impacting mental health are made at the local and state level. By asking them how they are prioritizing mental health, you put them on notice that this is an issue you care about and expect action on. Even better, if there is a particular area of mental health that you feel strongly about, come prepared to ask for specific policy changes (e.g., push for aggressive enforcement of parity laws that hold insurers accountable for equal coverage of mental health and addiction care).
Individuals can make a huge difference. Denise and Ben Denslow led passage of a suicide prevention and mental health parity law in Arizona. “Jake’s Law” was named after their son who died by suicide. Their actions are now saving lives. Denise wrote about it in a guest blog post on The Kennedy Forum’s website. Everyone’s story is important. If you need help getting engaged, definitely reach out to organizations like your local NAMI or AFSP chapter. You can also sign up for action alerts from groups like Inseparable.
What intrigues you about the legislative process?
I do like the process of pushing for action and working on language that key stakeholders can agree on to change the law. The legislative process also really rewards building political power, which can take many forms. For mental health advocates, a key way to build power is simply organizing families and other organizations to make the case for why proposed policies are critical. Local, dedicated advocates can often move mountains and help change what is possible, particularly if they frame the debate.
I also think legislators usually want to pass bills they think solve real problems. If you convince them there is a problem to solve and have shown why your proposal solves that problem, you’re likely to spark change. I occasionally see people negotiating against themselves at the beginning rather than asking for what they think is really needed. While you can’t simply ignore the political environment, putting forward ambitious proposals is often far preferable to small proposals that can quickly be chopped down to nothing.
What inspires you to do this work every day?
The work is intellectually stimulating, but it also affects everyone I know. There are definitely people I think of often who died far too early due to our failed system. To me, there’s great urgency here. Ensuring compliance with the Federal Parity Act is a critical piece of making reforms possible, because without financing through health insurance, our systems will always be underdeveloped and unable to meet the high demand.
