Biden Administration to Mandate Parity in Mental Health Coverage
The White House has stated that health insurers are not adhering to a 2008 law, a situation that is expected to provoke legal challenges from the insurance industry.
TroibNews 
The Biden administration is in the process of completing a significant expansion of regulations mandating that insurers provide mental health and addiction care on the same terms as other types of care.
Administration officials noted that insurers have disregarded a 2008 law designed to ensure mental health parity, prompting the need for enhanced rules and potential penalties for noncompliance. However, this decision is anticipated to spark legal challenges from the insurance industry.
“This final rule will stop the industry evasion that has led millions of people to pay for care even when they have insurance,” stated Neera Tanden, who leads President Joe Biden’s Domestic Policy Council, during a call with reporters prior to Monday’s announcement. “No one should have to drain their savings or go into debt to get help for themselves or their loved ones. President Biden and the vice president believe mental health is health.”
This initiative is expected to affect millions of Americans amid a mounting mental health crisis. Estimates suggest that most individuals with substance use disorders and mental health issues do not receive treatment.
The new rules, set to begin taking effect next year, will provide Vice President Kamala Harris an opportunity to highlight this administration’s measure on the campaign trail, as the expansion of mental health care access enjoys broad public support.
Certain aspects of the regulations, issued by the Departments of Health and Human Services, Treasury, and Labor, will be implemented when insurance plans renew in 2026, according to senior administration officials.
While the complete details of the regulations have not yet been disclosed, officials indicated that they largely reflect what the White House proposed last year.
Officials explained that the rules clarify that insurers cannot impose restrictions on tools like prior authorization and out-of-network payment standards for mental health care that are more stringent than those applied to other types of care.
Additionally, the regulations will require insurers to address significant disparities in access to mental health and substance use disorder care. The White House referenced a 2022 report to Congress from HHS, Labor, and Treasury indicating that none of the 156 insurance plans and issuers evaluated adhered to the requirements for measuring compliance with the 2008 law.
Tanden had previously expressed to PMG the hope for a collaborative approach to enforcement “without the sticks,” but emphasized that the administration will “fully enforce the parity law.”
This stance is likely to provoke considerable pushback from insurers, who contend they are being unjustly singled out.
The lobbying group for insurers, AHIP, has pointed to workforce shortages as the primary reason for barriers to accessing care. Meanwhile, other insurers, including the Blue Cross Blue Shield Association, argue that the new regulations could lead to unintended consequences, such as jeopardizing patient safety by compelling plans to accept lower-quality providers. BCBSA has called for a more “comprehensive approach” addressing workforce shortages, licensing, and related issues.
Concerns have been raised that employers may cut back on their mental health coverage due to the expanded requirements and the potential costs associated with them.
The regulations are expected to encounter legal challenges and may be vulnerable, particularly given that the Supreme Court recently overturned the Chevron doctrine, which maintained that courts should uphold federal agency regulations based on a “reasonable” interpretation of unclear statutes.
Despite this, senior administration officials have expressed confidence that the regulations have been crafted to align with applicable laws.
Ramin Sohrabi contributed to this report for TROIB News
Administration officials noted that insurers have disregarded a 2008 law designed to ensure mental health parity, prompting the need for enhanced rules and potential penalties for noncompliance. However, this decision is anticipated to spark legal challenges from the insurance industry.
“This final rule will stop the industry evasion that has led millions of people to pay for care even when they have insurance,” stated Neera Tanden, who leads President Joe Biden’s Domestic Policy Council, during a call with reporters prior to Monday’s announcement. “No one should have to drain their savings or go into debt to get help for themselves or their loved ones. President Biden and the vice president believe mental health is health.”
This initiative is expected to affect millions of Americans amid a mounting mental health crisis. Estimates suggest that most individuals with substance use disorders and mental health issues do not receive treatment.
The new rules, set to begin taking effect next year, will provide Vice President Kamala Harris an opportunity to highlight this administration’s measure on the campaign trail, as the expansion of mental health care access enjoys broad public support.
Certain aspects of the regulations, issued by the Departments of Health and Human Services, Treasury, and Labor, will be implemented when insurance plans renew in 2026, according to senior administration officials.
While the complete details of the regulations have not yet been disclosed, officials indicated that they largely reflect what the White House proposed last year.
Officials explained that the rules clarify that insurers cannot impose restrictions on tools like prior authorization and out-of-network payment standards for mental health care that are more stringent than those applied to other types of care.
Additionally, the regulations will require insurers to address significant disparities in access to mental health and substance use disorder care. The White House referenced a 2022 report to Congress from HHS, Labor, and Treasury indicating that none of the 156 insurance plans and issuers evaluated adhered to the requirements for measuring compliance with the 2008 law.
Tanden had previously expressed to PMG the hope for a collaborative approach to enforcement “without the sticks,” but emphasized that the administration will “fully enforce the parity law.”
This stance is likely to provoke considerable pushback from insurers, who contend they are being unjustly singled out.
The lobbying group for insurers, AHIP, has pointed to workforce shortages as the primary reason for barriers to accessing care. Meanwhile, other insurers, including the Blue Cross Blue Shield Association, argue that the new regulations could lead to unintended consequences, such as jeopardizing patient safety by compelling plans to accept lower-quality providers. BCBSA has called for a more “comprehensive approach” addressing workforce shortages, licensing, and related issues.
Concerns have been raised that employers may cut back on their mental health coverage due to the expanded requirements and the potential costs associated with them.
The regulations are expected to encounter legal challenges and may be vulnerable, particularly given that the Supreme Court recently overturned the Chevron doctrine, which maintained that courts should uphold federal agency regulations based on a “reasonable” interpretation of unclear statutes.
Despite this, senior administration officials have expressed confidence that the regulations have been crafted to align with applicable laws.
Ramin Sohrabi contributed to this report for TROIB News
