The Senate passed a much-needed opioids package last week – on the 10th anniversary of the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires most insurers to cover illnesses of the brain, such as depression or addiction, no more restrictively than illnesses of the body, such as diabetes or cancer.
Ironically, the package included no parity provisions to guarantee that those with mental health and substance use disorders would have equal access to care. Consequently, the discrimination fueling our national crisis will continue.
Measures that would have incentivized compliance and given regulators the teeth they need to crack down on insurance companies that are in violation of the law were left on the cutting room floor. You see, it’s hard to buck the powerful insurance industry, even as it continues to treat mental health and addiction as separate and unequal from the rest of medicine. Without the federal government doing its job, the responsibility falls on the consumer, often in the middle of personal crisis, to demand parity through a cumbersome appeals system.
That is why so many gathered to commemorate the 10th anniversary of the signing of MHPAEA on Oct. 3 and launch the Don’t Deny Me Campaign, which will empower people to file appeals and take their denials public. Only by exposing “denial” in our society’s attitude toward brain diseases can we begin to call out the insurance industry and its discrimination against those with mental health and substance use disorders.
Having served on the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, I do want to call out some of the very positive elements in the package, such as provisions to increase access to FDA-approved medication-assisted treatment (MAT) and strengthen the provider workforce, while beginning to break down the Institution for Mental Disease (IMD) exclusion. In addition to these important steps there is a call for the Attorney General and Secretary of Health and Human Services (HHS) to issue long-overdue telemedicine final regulations, which will open up access to care not only in rural health but across the nation. On top of this, I was pleased to see aspects of the social determinants of health woven into the legislation, including a requirement for HHS to issue best practices on recovery housing.
These changes will undoubtedly help to create the infrastructure we need to save lives; however, they are small concessions given the size and scope of the public health crisis we still face. It is important to recognize that the legislation relies on grants, not sustained funding infused into our health care system to finally treat the brain on par with the body. And the package falls dreadfully short of delivering the billions of dollars necessary for lasting change. We wouldn’t dare treat cancer this way. Until we make treating mental health and substance use disorders – which affect 1 in 4 Americans – the urgent national priority that it is, the crisis will roll forward. We want justice, not small steps and pity.
Due to the lack of parity provisions in the package, progress will be slow and unsustainable, and families will continue to suffer. Over the years, I have heard from countless people who have had to take out second and third mortgages on their homes or deplete college funds and 401Ks to pay for treatment their health insurance should have covered.
Many people have to quit their jobs to become full-time health care advocates for loved ones. Partners are often ripped apart by the stress caused by medical debt. Mothers spend countless hours on the phone with insurers while their child is in treatment, instead of using that time for desperately needed self-care.
Despite the disappointments of the opioids package, I am more determined than ever to continue fighting for a system in which regulators and payers are held accountable for enforcement and compliance.
Both federal and state lawmakers and regulators have a role in this. The past few years have seen great progress in state parity statutes, with Illinois, Texas, Colorado, New Jersey, Maryland, New York, Rhode Island, and Delaware emerging as leaders. However, in a report recently released by the The Kennedy-Satcher Center for Mental Health Equity in the Satcher Health Leadership Institute at Morehouse School of Medicine, The Kennedy Forum, The Carter Center, and Well Being Trust, 32 states received failing grades for statutes designed to ensure equal access to mental health and addiction treatment. We can do better. States are the primary enforcement authority of the Federal Parity Law. Their responsibilities cannot be understated.
These past ten years have brought with them both trials and victories. Change takes time and dedication. There is still much work to do, but as my father once said, “The work begins anew. The hope rises again. And the dream lives on.”
Patrick J. Kennedy