Today is the deadline for the Trump Administration to decide whether it should defend a Biden-era rule beefing up enforcement of mental health parity and addiction coverage. It should not bother. Mental health parity is a set of rules and regulations that require health plans to cover mental health treatments to the same level as it does for physical health. The original act dates back to 1996, while addiction equity of treatment was added in 2008. At its most basic, mental health parity requires health plans to cover mental health conditions to the same dollar limits as physical health care. The Affordable Care Act (2010) did away with both annual caps on benefits and lifetime caps on benefits. That means in theory the sky is the limit to how much care health care members can expect. The following is from Kaiser Family Foundation Health News:
Although a federal parity law has been on the books since 2008, the regulations in question were issued last September. 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.
Within the dense 166-page final rule, two provisions have garnered particular attention: first, that insurers provide “meaningful benefits” — as defined by independent medical standards — 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’t cover screening alone for opioid addiction; they must also cover medications to treat opioid use disorder.
What could be wrong with regulations beefing up mental health coverage? For one thing, there are no objective standards that can be used to measure mental health status like there are for physical health. For instance, complete blood counts and diagnostic scans are often used to diagnose diseases of the body. By contrast, mental health status is a subjective opinion between therapists and patients. Consider this 2002 brief analysis by John Goodman and Wess Mitchel:
An apparent reflection of the problem of moral hazard is a National Bureau of Economic Research study finding that 38 percent of all mental health patients representing 28 percent of all treatment visits are people who do not have any mental health disorder.
Some people like to talk to therapists, despite having no mental health disorder. In some circles talking to a therapist is considered a status symbol, or something that sophisticated people do. Hollywood has ingrained talk therapy into popular culture with television shows like Bob Newhart. It has the potential to turn garden variety angst or normal anxiety into an expensive, ongoing insurance benefit. More from John Goodman and Wess Mitchel:
Numerous studies have found that patients on their own improve as much and as often as patients in therapy; other studies have found that mental health professionals are no more effective than nonprofessionals, such as school counselors with minimal skills. Based on a review of more than 500 scholarly studies, Carnegie-Mellon University Professor Robyn Dawes concludes there is overwhelming evidence that:
The therapists credentials Ph.D. or M.D., for example are completely unrelated to the effectiveness of therapy. The type of therapy is generally unrelated to its effectiveness. The length of therapy is unrelated to its success.
Another major problem with mental health parity is the shortage of counselors. Most do not accept insurance. They can fill their appointment calendars without the hassles of insurance billing and collecting. Biden-era regulations are unlikely to change that.
There have been numerous advances in mental health counseling in the past couple of years. Most of these have to do with telemedicine, being able to talk to a therapist from anywhere. Furthermore, artificial intelligence and asynchronous counseling (similar to emailing back and forth) hold promise to make counseling more efficient. These are not so much medical advancements as technological advancements. Studies from a couple of years ago found people talking to a mental health AI chatbot felt relief even if they knew they were talking to an AI chatbot. In the future there should be a distinction between talk therapy that is good for mental health but not medically necessary and medically necessary mental health therapy, which would still be mandated without the Biden-era regulations.
Read more at KFF Health News: Trump Team Faces Key Legal Decision That Could Put Mental Health Parity in Peril
Also:
The Case Against Mental Health Parity, Part I: Faulty Assumptions
The Case against Mental Health Parity, Part II: Predictable Harms
The Case Against Mental Health Parity, Part III: Does the Care Really Work?