Understanding the fight for mental health parity and what it means for you
Living with mental health challenges can feel like navigating a maze—each turn revealing new obstacles, often hidden behind policies and regulations. For many, understanding whether their insurance will truly support their mental health needs can seem overwhelming, especially when the rules are constantly shifting. When insurance coverage for mental health and addiction treatment isn’t on par with physical health care, it can leave people feeling isolated, frustrated, and even trapped in a cycle of untreated illness.
The upcoming decision by the Trump administration to defend or dismantle the Biden-era regulations on mental health parity isn’t just a political debate—it’s a decision that could impact millions of lives, including yours or someone you love. These regulations represent a crucial step toward making mental health care accessible, affordable, and equitable, especially in a country where many struggle to access the care they need.
Why mental health parity regulations matter for everyday lives
Imagine trying to get help for anxiety or depression, only to find that your insurance limits your access or makes it so difficult that it feels impossible. That’s a reality for many who face barriers like prior authorization hurdles, out-of-network costs, or coverage gaps. The new regulations aim to close these gaps by requiring insurance companies to offer “meaningful benefits” for mental health conditions—similar to what they provide for physical ailments like diabetes or heart disease.
For instance, if your insurer covers insulin for diabetes, they should also cover medications for opioid use disorder, not just screening. They should also evaluate how their policies work in real life—are people being forced out-of-network more often for mental health care? If so, the insurers would need to fix these policies. These are practical steps towards ensuring that mental health isn’t sidelined or treated as an afterthought.
People searching for mental health insurance coverage often ask, “Why is it so hard to get mental health care through insurance?” or “Does my insurance cover therapy or medication?” The truth is, despite laws on the books since 2008, enforcement has lagged, leaving many feeling like their mental health needs are less valid or less supported than physical health needs. The recent regulations seek to change that by emphasizing outcomes and actual patient experiences—making sure that mental health care is genuinely accessible.
What’s at stake if these regulations are not defended?
The stakes go beyond policy jargon. When mental health care isn’t effectively covered, people’s lives suffer. For many, the barriers mean delaying or forgoing treatment altogether, which can turn manageable conditions into crises. The mental health system is already strained by shortages of providers—many psychologists and psychiatrists are overwhelmed, and insurance reimbursement rates often discourage providers from accepting insurance at all.
If the regulations are rolled back, advocates warn that the structural issues may remain unresolved. The core problem isn’t just insurance rules; it’s the scarcity of providers willing or able to accept insurance because of low reimbursement rates. Without addressing this underlying issue, changing policies alone might not improve access—patients could still face long waits, high costs, or limited options.
For those living with mental health challenges, this ongoing struggle can feel like fighting an uphill battle with few allies. The hope is that policies will evolve to support both the supply of mental health services and the fairness in coverage—so that no one has to choose between paying rent or paying for mental health care.
**The path forward involves more than just policy.** It’s about creating a system that recognizes mental health as an essential part of overall well-being. It’s about breaking down barriers—financial, logistical, and societal—that keep people from getting the help they deserve. Whether these regulations stay or fall will influence how many people can access therapy, medication, and support—fundamental components of a healthier, more resilient society.
Learn More: Trump Team Faces Key Legal Decision That Could Put Mental Health Parity in Peril
Abstract: The Trump administration must soon make a decision that will affect millions of Americans’ ability to access and afford mental health and addiction care. The administration is facing a May 12 deadline to declare if it will defend Biden-era regulations that aim to enforce mental health parity — the idea that insurers must cover mental illness and addiction treatment comparably to physical treatments for ailments such as cancer or high blood pressure. 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. 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’s policies, then those policies must be adjusted. In January, a trade association representing about 100 large employers sued the federal government, claiming the regulations overstepped the administration’s authority, would increase costs, and risked reducing the quality of care. The ERISA Industry Committee 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. ERIC’s lawsuit, filed days before President Donald Trump’s 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. Mental health clinicians, patients, and advocates are urging the administration to fight back. “What we’re trying to do is make the spirit of parity a practical reality,” said Patrick Kennedy, a Democratic former U.S. representative who sponsored the 2008 parity law in the House and co-founded the Kennedy Forum, which advocates on mental health issues. This is “an existential issue for the country, public health, for every aspect of our society.” A 2023 national survey 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. This lack of treatment harms people’s physical health too, with research suggesting that undertreating depression can complicate chronic conditions, such as diabetes. Kennedy hopes that connection will prompt support from the Trump administration, which has made chronic disease a central focus of its “Make America Healthy Again” agenda. “You’re never going to get MAHA if you don’t integrate mental health,” Kennedy said, mentioning the broad health movement embraced by his cousin HHS Secretary Robert F. Kennedy Jr. But James Gelfand, president and CEO of ERIC, said the regulations are a misguided attempt to solve the nation’s mental health care crisis. People’s 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, “No amount of penalties on employers” or new parity regulations “is going to change that dynamic until we get more of these providers.” 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 by the research institute RTI International suggests it has more to do with payment. 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. ‘They Bank on You Just Giving Up’ Psychiatric nurse practitioner Gabrielle Abelard employs about 40 clinicians in her therapy practice, which serves about 2,500 clients across Massachusetts each year. One of the programs she’s 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’s home over months and work with the family, the child’s doctors, and school staff. “A 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,” Abelard said. But insurance barriers sometimes hinder the services. Abelard’s 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. Continuing services has cost her tens of thousands of dollars, she said, and months of bureaucratic hurdles to obtain back payments from insurers. “They bank on you just giving up,” she said. A goal of the landmark 2008 Mental Health Parity and Addiction Equity Act was to decrease dilemmas such as Abelard’s. 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. As a result, true parity remained elusive, said Deborah Steinberg, a senior health policy attorney at the nonprofit Legal Action Center. 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. As the federal government reviewed some of those analyses, it discovered numerous parity violations. In a 2022 report, 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. The regulations issued in September aimed to provide insurers more guidance on the 2020 law and close loopholes that allowed such disparities, Steinberg said. ‘Supply Is the Biggest Problem’ 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. Steinberg called the provision “a really important change.” But Gelfand, president of the employer association suing to stop the regulations, said it ignores the complexity of mental health care. Many factors outside employers’ and insurers’ 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’s personal preference. Mental health clinicians know there’s high demand for their services, so they have a lot of market power. That “is creating the bad behavior from these providers,” Gelfand said, such as refusing to accept insurance and not submitting out-of-network bills on clients’ behalf. “Supply is the biggest problem,” Gelfand said. 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. 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. But fixing this isn’t straightforward, as many companies worry about rising premiums and the sustainability of benefits. Instead, organizations like ERIC recommend solutions like expanding mental health training, telehealth options, and integrating mental health care into primary care settings. These strategies aim to boost mental health care access without solely relying on insurance policy changes.
Dr. David Lowemann, M.Sc, Ph.D., is a co-founder of the Institute for the Future of Human Potential, where he leads the charge in pioneering Self-Enhancement Science for the Success of Society. With a keen interest in exploring the untapped potential of the human mind, Dr. Lowemann has dedicated his career to pushing the boundaries of human capabilities and understanding.
Armed with a Master of Science degree and a Ph.D. in his field, Dr. Lowemann has consistently been at the forefront of research and innovation, delving into ways to optimize human performance, cognition, and overall well-being. His work at the Institute revolves around a profound commitment to harnessing cutting-edge science and technology to help individuals lead more fulfilling and intelligent lives.
Dr. Lowemann’s influence extends to the educational platform BetterSmarter.me, where he shares his insights, findings, and personal development strategies with a broader audience. His ongoing mission is shaping the way we perceive and leverage the vast capacities of the human mind, offering invaluable contributions to society’s overall success and collective well-being.
