By Paul Gionfriddo, MHA President and CEO
Ever since the Mental Health Parity and Addiction Equity Act was passed in 2008, Mental Health America has worked tirelessly with other advocates to make mental health parity a reality.
Unfortunately, during the last decade, parity has proven elusive. Public officials, insurers, and regulators have struggled to find ways to implement this simple concept: that behavioral health services be delivered to individuals and paid for in the same way as other health services.
There are a lot of reasons for this. And the challenges can be complex at times. But what it often boils down to is money – what gets paid for, and how much insurers are willing to pay.
There was a potential game-changer last week after a decade of frustration. A Federal judge in Northern California issued a ruling in a class action lawsuit entitled Wit v. United Behavioral Health (UBH).
In the decision, U.S. Chief Magistrate Judge Joseph C. Spero wrote that UBH’s coverage decisions were based "as much or more on its own bottom line as on the interests of the plan members." That’s pretty direct. UBH – the nation’s largest managed behavioral health care company – has been found liable for protecting its bottom line at the expense of its members.
This has got to stop now. Insurers need to put members with mental health conditions first.
They should improve their bottom lines not by denying care but by offering to pay for care both before crises occur and afterward to aid in recovery.
That’s why I joined this week with three colleagues – former U.S. Representatives James Ramstad and Patrick Kennedy, who co-authored the 2008 law, and Mary Giliberti, the CEO of NAMI – in writing a series of letters to employers, states’ attorneys general, and elected officials. In each of those letters, we called attention to the decision and asked the recipients to use the legal powers they already enjoy to assure that individuals’ behavioral health needs are valued the same as their physical health needs.
In the case of large employers – many of whom are exempt from state insurance regulations under ERISA – we reminded them that they have a fiduciary responsibility to make certain that the coverage they offer to employees complies with the parity law.
In the case of state regulators, we asked them to take immediate action to enforce parity provisions for plans that are not exempt from regulations – and reminded them of their legal responsibility to do so.
In the case of elected officials, we asked them to put pressure on insurers and regulators to carry out their responsibilities under the law by holding hearings and inviting constituents to share their stories of how difficult it is to get behavioral health conditions covered and paid for fairly.
Unfortunately, too many of us have direct experience with inadequate mental health coverage. In times of need it leads to stress, anger, confusion, and deepening health crises.
And here’s some context for how pervasive the need for good mental health coverage is. Nearly half of the one thousand young people who take an MHA mental health screen each report feeling so bad that they have thought about suicide.
It’s not just young people whose needs are striking. According to a recent workplace survey conducted and published by MHA, the vast majority of workers say that workplace stress contributes to adults engaging in harmful behavior at least some of the time. That should be an eye-opener for all employers – especially the biggest of them.
And yet, the people in whom we have all placed our trust to pay for the care and services our children and adults need all need too frequently begin and end the conversation with a simple denial.
That’s effectively what the judge said. And the Federal Court has now ruled that this denial is not legal.
At Mental Health America, we believe in acting before Stage 4. And we’re asking employers, regulators, and public officials to join us in that call.
You can read copies of our letters here. Please share them widely.
