Can’t find a therapist? These new rules could change that.

Biden's new requirements will make it harder for insurers to limit mental health care.

It’s generally easier to treat an ulcer than an eating disorder in the United States. That’s because insurance companies historically have handled mental health services differently than physical and surgical care. We could have excused this before knowing how much our minds affect our overall wellbeing, but now that science confirms it, the approach is out of touch. It’s also illegal.

That’s why the Biden administration on Monday announced new rules to strengthen an existing law to ensure the 175 million Americans paying for private health insurance get better access to care for mental health and substance use issues.

“Health care, whether for physical or behavioral conditions, is health care,” Health and Human Services Secretary Xavier Becerra said in a statement Monday. “No one should receive lesser care for one or the other. That’s the law. The rules we issue today make that clear.”

The timing might seem like an election stunt, but it is the result of a years-long process that included a public comment period. This is genuinely good consumer protection news for people of all political persuasions.

Running on empty

The new rules update the Mental Health Parity and Addiction Equity Act that Congress passed in 2008. That law was supposed to make insurers treat beneficiaries’ minds and bodies equally. But it lacked specifics in key areas, and companies took advantage of the vagaries to avoid complying with the law. That’d be like borrowing a friend’s car and returning it with an empty tank because they didn’t tell you, and you didn’t ask, what kind of gas it takes.

Since private insurers are profit-driven, and updating systems and expanding mental health benefits are expensive in the short-term, they weren’t incentivized to do the right thing. Over the long run, treating mental illness and addiction would reduce the cost of treating physical ailments by the billions of dollars. Despite that, a lack of parity in health coverage has added to the cost and stigma around mental health and substance use services.

It has also made a lot of people give up trying to get help. This has real consequences. In 2020, less than half of all adults with mental illness received treatment. And nearly 70 percent of kids who seek care for mental health or substance use cannot get it. This is a problem in a country where as many as two in five adults have anxiety or depression and suicide is the second leading cause of death among young people, ages 10 to 24 years old.

Tug-of-war

Over the last four years, folks in the Labor Department’s Employee Benefits Security Administration have prioritized changing this. They’ve been coaching insurers on how to comply with the law, teaching employers how to push insurance companies to offer more robust, legally compliant plans for their staff and even case-managing individual complaints to make sure insurers follow the law. (I wrote about this for The Washington Post a year ago. Here’s a gift link to get around the paywall.)

After the Biden administration released its proposed rule to strengthen the Parity Act for public comment last year, insurers and employer groups warned that if they had to comply with the law, it would drive up consumer prices and some employers might even drop mental health care benefits all together. Patient advocates told me this was baloney — baseless scare tactics by the insurance lobby.

Now that the rules are final, effective January 1, 2025, for group health plans and January 1, 2026, for individual plans, insurers will be prohibited from having more restrictive networks and financial requirements for mental health and substance use services than for other services. Senior administration officials say the dates were set out of respect for how much goes into systems change, a process that not only involves the insurers but the companies and individuals that buy their products.

The new rules

Within a couple years, vagaries should no longer be an excuse for insurers. They’ll have to begin filling the gas tank.

The regulations aims to address out-of-network costs, which are four times higher for mental health care. And it prohibits insurers from charging steeper co-pays, requiring pre-authorizations or imposing treatment limitations on mental health and behavioral services than they apply to medical and surgical services.

To avoid any confusion, the new rules will provide examples of what does and does not comply with the Parity Act. Companies will be required to collect data and evaluate how their mental and physical benefits compare, and then take action to make sure they’re on par.

If I have a broken finger, for example, plenty of doctors will take my insurance, but if I need treatment for PTSD, it’s hard to find good therapists in-network. Many mental health providers don’t join insurance networks because the companies place limits on care, don’t reimburse well or require so much paperwork that it takes time away from seeing people.

Under the new rules, insurers must assess how many therapists are in network and, if that’s not on par with physical health specialists, the company has to find ways to attract providers. That could mean offering higher payment rates or reducing bureaucracy. Over time, this has the potential to change the health care landscape so that people get care before a crisis unfolds.

Consumer power

Compliance will be a work in progress, and senior administration officials admit companies may still find ways to exploit potential loopholes. The Labor Department will enforce the law, but officials say it will, in essence, catch more flies with honey — focusing on collaborating and providing clarity to insurers who need to improve. Good and bad actors will be named in a regular report to Congress, which could spur action if the public is paying attention.

Ultimately, the greatest pressure insurance companies — and employers buying their plans — likely will feel is from informed consumers who know their rights. American attitudes around mental health and addiction issues have evolved to recognize that these are not the moral failings of an individual, but are health issues affected by biological, psychological and social, political and economic factors.

Addressing the upstream drivers of mental health issues, including trauma caused by gun violence, racial, economic and sex-based discrimination, will be an even greater mountain to climb than getting insurers to comply with the Parity Act. The ascent isn’t impossible, though. In fact, it’s a good challenge now that we’re strengthening laws that affirm our right to better health care.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.

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Hi, I’m Kate…

I’m a journalist and documentary filmmaker focused on the relationship between mental health and democracy. At The Washington Post, I won the Pulitzer Prize for Public Service with colleagues covering the Jan. 6 U.S. Capitol attack. I also pioneered a mental health column and led a film unit. In 2024, after 20 years in newsrooms, I opted out of the corporate media tumult to create Invisible Threads, a storytelling venture committed to wellbeing through narrative transformation. We uncover individual, communal and systemic forces and stories that keep people sick and separate in order to illuminate honest paths to repair. I’m also a journalist-in-residence at Georgetown University’s research and design unit, The Red House. This chapter deepens work I’ve pursued for two decades, from reporting on an authoritarian regime in post-genocide Cambodia, to the decline of democracy in Hong Kong, to the 2021 U.S. insurrection. By subscribing to this newsletter, you’ll receive new columns, interviews and resources every couple weeks.

What bowled me over…

When Joe Feldman’s daughter needed serious mental health treatment in high school, their insurance company refused to pay, saying the intervention was “not medically necessary.” The Illinois dad paid for the treatment out of pocket, then sued the company and won. He has turned the ordeal into a mission to help others.

Feldman has become a national mental health advocate and is the founder of covermymentalhealth.org, a free website full of tips for people in all 50 states to fight private insurance companies that are violating consumer rights and the law. It includes a step-by-side action plan, a downloadable worksheet to document your case and a template clinicians can use to prepare a response letter to insurance company denials.

What I’d invite you to explore…

Struggling to Find an In-Network Mental Health Provider? Here’s What You Can Do. — Pro Publica

Don’t let your insurance company win so easily. Call this number. — Washington Post

5 unlikely insights on trauma to safeguard democracy — Invisible Threads

What I’d invite you to do…

Send someone this edition of Invisible Threads and the website covermymentalhealth.org so that more people can know their legal rights to mental health care and learn ways to advocate for them.