Insurers and Employers Say Biden's New Mental Health Plan Is Likely to Backfire: 'Patients Will Pay More'
The road to failure is often paved with the “good intentions” of politicians — especially Democrats — and some are now warning that President Joe Biden’s new mental health plan won’t end up helping those most in need, but may actually reduce their access to needed care.
In July, Biden endorsed plans he claimed would get health insurance companies to pay for mental health care more often.
The policy changes the administration is suggesting would affect the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), which originally tried to force insurers to provide more mental health coverage, but missed the mark in many ways.
The MHPAEA aimed to force insurers to cover mental health treatment at the same level as physical health matters.
Serious mental illness can cost a lot of cash, sometimes up to $100,000 or more annually, according to NPR. So, for many, unless they have insurance coverage, they often have to go without treatment.
The proposal is asking for a list of changes to the MHPAEA, one of which is to better codify definitions and data concerning mental health. With definitions varying wildly, it is hard to get insurance companies on board to cover things if they can’t even identify what those issues, treatments, and diagnoses are.
The rules would also impose new requirements for how insurers place limits and exceptions on coverage.
It would also close a loophole that originally exempted state and local governments from having to comply with the mandates, allowing states and local government to continue denying most mental health coverage.
But according to Axios, insurers and healthcare providers are warning that the new rules Biden is proposing will have serious unintended consequences. One insurance trade group is even suggesting that the whole rules package be scrapped.
The administration’s new rules are being lambasted as “burdensome.” If we can use Obamacare as any sort of indication, “burdensome” is probably the nicest thing you can say.
The rules are “so burdensome that many of our members will have no other choice but to re-think the type and level of their plans’ coverage” of mental health benefits, said the ERISA Industry Committee in its Oct. 17 letter to the Office of Health Plan Standards and Compliance Assistance Employee Benefits Security Administration, according to Axios.
ERIC insisted that the proposed rules go beyond the Biden administration’s legal authority to place demands on the limits on mental health and substance use treatment. The group also hinted it could sue if the policy becomes adopted.
The trade group was not the only one to speak in opposition. America’s Health Insurance Plans (AHIP) also blasted the proposal and urged the federal government to rescind the whole package and go back to the drawing board.
Members of the Insurance industry also defended their use of “prior authorization” rules — which causes patients to apply to insurance companies for authorization ahead of treatment — saying that it is the best way they can ensure that patients are getting the proper treatment based on their history of care.
The Blue Cross Blue Shield Association noted that if the prior authorization rule is scrapped in accordance the Biden’s new rules, it will cause patients to get uneven treatment. “If this approach is restricted, patients will pay more for treatment that varies widely in quality,” Blue Cross Blue Shield wrote.
The fear insurance companies have is that doctors and health care providers will start throwing all sorts of treatments at patients without regard to need or effectiveness if insurance companies are simply expected to cover any sort of treatment at all without limits.
Still, some mental health professionals support the Biden proposal, Axios added.
“Similar metrics already in use for determining whether mental health treatments are too costly or too limited in duration have increased mental health parity compliance, one advocacy coalition wrote to officials,” Axios wrote.
Indeed, the Mental Health Liaison Group even suggested that Biden officials delete some of the exceptions for insurers that the new rules do include.
In all, the new rules are fixes, upon fixes, upon more fixes showing how inefficient and illogical government action often is and how once government gets involved in something, it is a never-ending act of tail chasing, rules “updating” and law rewrites for every problem they missed from the beginning or created in the first place.
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