Mental health is a growing concern for state and federal lawmakers as the toll from Covid-19 becomes increasingly clear. With record levels of opioid overdoses reported, along with increases in eating disorders and mental health emergency room visits for children, a bipartisan group in the House and Senate is pushing to write a comprehensive bill this summer. which includes stricter enforcement of insurers who scoff at mental health. parity rules.
The House and Senate committees will hold two hearings this week after holding several last week and hearing testimony from Surgeon General Vivek Murthy.
President of the Finance Senate Ron Wyden (D-Ore.), whose younger brother was schizophrenic and died in his 50s after decades of treatment that consumed much of his father’s savings, said in an interview that improving existing parity laws is a top priority.
“These big insurance companies are trying to find every way they can to reduce coverage,” he told POLITICO. “This is a very profitable industry and a lot of people feel like they don’t get much for their money, apart from a lot of jazz on the other end of the phone.”
Insurers bristle at the accusations, telling Congress that they have tried to comply with a complex law and that Congress should not impose fines on them.
“Congress should delay additional legislation related to [mental health parity] compliance,” AHIP wrote in a letter to Sens. miguel bennett (D-Col.) and John Cornyn (R-Texas) in an October letter shared with POLITICO. The group argues that the Labor Department must first provide the industry with better examples of how they should document their compliance with the law before moving forward with ways to punish them.
“We’ve made a lot of good faith efforts to comply,” Grow said in an interview. “It’s been a learning process for everyone.”
Dozens of companies and groups have stepped up their lobbying in recent months as efforts by Congress have gathered momentum, according to a POLITICO analysis of lobbying disclosures.
Among the most active are health insurance companies and their corporate allies who are mobilizing against the new enforcement measures. In his narrative, they are being singled out unfairly when there is a lot of blame to be doled out for the problem of unaffordable and inaccessible mental health care.
“They act like they’re big bad insurers making tons of profits instead of poor doctors going out of business,” complained James Gelfand, executive vice president of public affairs for the ERISA Industry Committee, a group that represents health departments. human resources of large companies. and has joined insurers against the proposed regulations. “The great hypocrisy here is that doctors do not take any personal responsibility for their patients. … They actively choose to participate in zero insurance networks. They go only in cash and tell the patient: ‘Good luck’”.
Other groups fighting alongside insurers against the bills warn they could allow mental health care providers to charge exorbitant fees for care and force insurers to pick up the tab, potentially raising premiums for everyone. .
Mental health care providers, seeking to counter insurance industry claims, are also stepping up their lobbying and urging Congress to consider penalizing insurers.
“This is the big deal for us on the hill,” Saul Levin, CEO and chief medical officer of the American Psychiatric Association, told POLITICO. “If you can’t provide care, what are we here for?”
There are two proposals moving on Capitol Hill that could be included in a broader mental health package later this year, or included in a revamped version from the Democrats. social spending bill. One would give states resources to step up enforcement against insurers, and another would give the Labor Department the ability to impose monetary penalties on plans that don’t follow parity laws. Despite gridlock in Congress and a tight schedule leading to a midterm election, lawmakers hope the severity of the crisis will drive policy.
“There is a lot of pent up anger and angst right now. Many people have lost loved ones,” the representative said. Donald Norcross (DN.J.), who is leading the effort in the House. “How many more people have to die while [insurance companies] invest in stopping these reforms?”
Lawmakers say the need for legislative victories after a series of high-profile failures is also driving mental health.
“As soon as I realized that Joe Manchin had drawn a line in the sand [on Build Back Better] and it wasn’t going any further, and even more recently when he said, ‘He’s dead,’ I knew we had to think about what our next priorities are,” the rep said. susan wild (D-Pa.). “And mental health is always good to focus. That’s one of the areas where I really think we can get a lot of bipartisan support.”
Few issues stand a chance of winning 60 votes in the current congressional climate, but previous mental health parity bills have won bipartisan support and Republicans have signaled an openness to tougher enforcement, particularly after the U.S. report. The Departments of Labor and Health and Human Services and the Treasury dropped what some described as a wake-up call in late January.
“Mental health is obviously part of your overall health,” said Cornyn, whom Wyden has tapped to design the “access to care” part of the mental health package for the Senate Finance Committee. “If there are existing laws that require [parity]I think we have a compliance problem.”
Under the law, insurers are not supposed to charge higher copays, offer smaller coverage, or deny more claims for mental health and addiction care than for other medical or surgical services. However, federal investigators often found this It happens, and regulators don’t have many tools to quickly hold insurers accountable. Some states have enacted their own stricter parity laws and enforcement schemes with varying degrees of success, but violations remain common across the country.
For example, according to the new report, health insurers “covered nutritional counseling for medical conditions such as diabetes, but not for mental health conditions such as anorexia nervosa, bulimia nervosa, and binge eating disorder.”
Insurers found to be in violation may be forced to reimburse patients for services that the companies should have covered. But lawmakers and advocates alike hope the threat of fines could prevent violations from happening in the first place.
“This deterrent effect and ensuring that people can get the care they need when they need it is really critical because otherwise it’s a mole-type situation where it becomes very difficult to police,” said David Lloyd, a senior policy official. . advisor at the Kennedy Forum studying coverage and parity in mental health.
