Although a federal parity law<\/a> has been on the books since 2008, the regulations in question were issued last September<\/a>. They represent the latest development in a nearly two-decade push by advocates, regulators, and lawmakers to ensure insurance plans cover mental health care equitably to physical health care.<\/p>\n Within the dense 166-page final rule<\/a>, two provisions have garnered particular attention: first, that insurers provide \u201cmeaningful benefits\u201d \u2014 as defined by independent medical standards \u2014 for covered mental health conditions if they do so for physical conditions. For example, if insurers cover screening and insulin treatment for diabetes, then they can\u2019t cover screening alone for opioid addiction; they must also cover medications to treat opioid use disorder.<\/p>\n Second, insurers must go beyond the written words of their policies to measure how they work in practice. For example, are patients having to seek out-of-network care more often for mental than physical care? If so, and it relates to an insurer\u2019s policies, then those policies must be adjusted.<\/p>\n In January, a trade association representing about 100 large employers sued the federal government<\/a>, claiming the regulations overstepped the administration\u2019s authority, would increase costs, and risked reducing the quality of care. The ERISA Industry Committee<\/a> represents several Fortune 500 companies, such as PepsiCo and Comcast, which sponsor health insurance plans for their employees and would be directly affected by the new regulations.<\/p>\n ERIC\u2019s lawsuit<\/a>, filed days before President Donald Trump\u2019s inauguration, puts the onus on the new administration to decide whether to defend the regulations. If it chooses not to, the rules could be scrapped.<\/p>\n Mental health clinicians, patients, and advocates are urging the administration to fight back.<\/p>\n \u201cWhat we\u2019re trying to do is make the spirit of parity a practical reality,\u201d said Patrick Kennedy<\/a>, a Democratic former U.S. representative who sponsored the 2008 parity law in the House and co-founded the Kennedy Forum<\/a>, which advocates on mental health issues. This is \u201can existential issue for the country, public health, for every aspect of our society.\u201d<\/p>\n A 2023 national survey<\/a> found that more than 6 million adults with mental illness who wanted treatment in the past year were unable to receive it. Cost was one of the most common barriers.<\/p>\n This lack of treatment harms people\u2019s physical health too, with research suggesting that undertreating depression can complicate chronic conditions<\/a>, such as diabetes.<\/p>\n Kennedy hopes that connection will prompt support from the Trump administration, which has made chronic disease a central focus of its \u201cMake America Healthy Again\u201d agenda<\/a>.<\/p>\n \u201cYou\u2019re never going to get MAHA if you don\u2019t integrate mental health,\u201d Kennedy said, mentioning the broad health movement embraced by his cousin HHS Secretary Robert F. Kennedy Jr.<\/p>\n But James Gelfand<\/a>, president and CEO of ERIC, said the regulations are a misguided attempt to solve the nation\u2019s mental health care crisis.<\/p>\n People\u2019s difficulty accessing therapy or medication has less to do with insurance policy and more to do with a severe shortage of mental health care providers, he said, adding, \u201cNo amount of penalties on employers\u201d or new parity regulations \u201cis going to change that dynamic until we get more of these providers.\u201d<\/p>\n This point is at the heart of debate about parity issues. Is mental health care difficult to access because there are few providers, or are providers not accepting insurance because of low reimbursement rates? A recent study<\/a> by the research institute RTI International suggests it has more to do with payment.<\/p>\n The departments of Justice, Labor, and Health and Human Services declined to comment for this article. The Treasury Department, which is also involved in the lawsuit, did not respond to requests for comment.<\/p>\n \u2018They Bank on You Just Giving Up\u2019<\/strong><\/p>\n Psychiatric nurse practitioner Gabrielle Abelard<\/a> employs about 40 clinicians in her therapy practice<\/a>, which serves about 2,500 clients across Massachusetts each year.<\/p>\n One of the programs she\u2019s most proud to offer is intensive in-home therapy for children with serious behavioral challenges, such as intergenerational trauma, aggressive outbursts, and self-harm. Two clinicians visit the child\u2019s home over months and work with the family, the child\u2019s doctors, and school staff.<\/p>\n \u201cA big part of the work being done is helping to keep children in school, helping to keep them out of the hospital and even out of jail,\u201d Abelard said.<\/p>\n But insurance barriers sometimes hinder the services.<\/p>\n Abelard\u2019s staff has to obtain prior authorization from insurers before they can provide care. Then they have to reapply for authorization every two, three, or six months, depending on the insurer. When that reauthorization is delayed, Abelard faces a dilemma: continue seeing clients knowing insurers may not pay for those services or leave clients without care until the reauthorization comes through.<\/p>\n Continuing services has cost her tens of thousands of dollars, she said, and months of bureaucratic hurdles to obtain back payments from insurers.<\/p>\n \u201cThey bank on you just giving up,\u201d she said.<\/p>\n A goal of the landmark 2008 Mental Health Parity and Addiction Equity Act was to decrease dilemmas such as Abelard\u2019s.<\/p>\n But the bipartisan law primarily emphasized easy-to-measure treatment limits, saying insurers could not impose higher deductibles or copays for mental health care than they did for physical health care. What received less attention was how insurers should handle other limitations, such as prior authorization or fail-first requirements for patients to try certain therapies before they would be eligible for others.<\/p>\n As a result, true parity remained elusive, said Deborah Steinberg<\/a>, a senior health policy attorney at the nonprofit Legal Action Center<\/a>.<\/p>\n In 2020, Congress tried to address this through a new law, signed by Trump in his first term. The law required insurance plans to systematically analyze differences in certain treatment limitations for mental and physical health care and submit those analyses upon request to states and the federal governments.<\/p>\n As the federal government reviewed some of those analyses, it discovered numerous parity violations. In a 2022 report<\/a>, it detailed how some insurance plans covered nutritional counseling for diabetes, but not for anorexia or bulimia. Another plan required precertification for all outpatient mental health and addiction services but only for a select few outpatient medical and surgical services.<\/p>\n The regulations issued in September aimed to provide insurers more guidance on the 2020 law and close loopholes that allowed such disparities, Steinberg said.<\/p>\n \u2018Supply Is the Biggest Problem\u2019<\/strong><\/p>\n One of the biggest changes in the new regulations was the focus on outcomes, such as how often patients go out of network for mental versus physical care.<\/p>\n Steinberg called the provision \u201ca really important change.\u201d But Gelfand, president of the employer association suing to stop the regulations, said it ignores the complexity of mental health care.<\/p>\n Many factors outside employers\u2019 and insurers\u2019 control affect how often a patient goes out of network, he said, including the availability of providers in the area, regional variations in clinical practices, and the patient\u2019s personal preference.<\/p>\n Mental health clinicians know there\u2019s high demand for their services, so they have a lot of market power. That \u201cis creating the bad behavior from these providers,\u201d Gelfand said, such as refusing to accept insurance and not submitting out-of-network bills on clients\u2019 behalf.<\/p>\n \u201cSupply is the biggest problem,\u201d Gelfand said.<\/p>\n However, the RTI International study challenged that premise, with the authors noting that primary care physicians are in shorter supply than behavioral health providers yet have much lower out-of-network use.<\/p>\n The authors point to insurance reimbursements as the culprit instead. The study found that insurance reimbursements for behavioral health visits are, on average, 22% lower than for medical or surgical office visits. The low pay creates a disincentive for psychologists and psychiatrists to join insurance networks.<\/p>\n But the fix may not be as easy as raising reimbursement rates. Companies are already paying increasingly high premiums<\/a> for employees\u2019 health insurance and many are concerned about sustaining these benefits.<\/p>\n ERIC has championed<\/a> other strategies, such as reforming medical education and residency programs to produce more mental health care providers, increasing telehealth services, and training primary care doctors to address basic mental health concerns. The organization often lobbies state and federal lawmakers, writes letters<\/a> to regulatory agencies, and testifies before Congress<\/a> on these issues.<\/p>\n Narrowly focusing on insurance regulations could have unintended consequences, Gelfand said. Increased costs for health plans may get passed on to consumers. Or, in an attempt to keep costs down, insurers may narrow the size of their physical health care networks to match the mental health ones. In a worst-case scenario, employers could stop providing mental health benefits altogether.<\/p>\n Advocates say that\u2019s unlikely, since many employees have come to expect<\/a> this type of coverage, and employers recognize that providing mental health benefits can increase worker productivity<\/a> and retention<\/a>.<\/p>\n Patrick Kennedy also pointed to the bigger picture around these issues: If people do not have insurance coverage for mental health care, they\u2019re more likely to end up in crisis at the hospital or in the criminal justice system, he said. Their children may be sent to foster care. Taxpayers finance those systems.<\/p>\n \u201cWe all end up picking up the tab for not enforcing parity,\u201d he said.<\/p>\n But what calculation the Trump administration makes \u2014 and whether it defends or drops the new regulations \u2014 remains to be seen.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/www.walkwithremar.com\/wp-content\/uploads\/2025\/05\/Kennedy-resized-scaled.jpg\")
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