Legal framework for Mental Health insurance in the US and its Deficits

By Tanisha Malhotra, Year 11 North London Collegiate

Mental health essentially refers to the overall well-being of a person, but mental health conditions are becoming increasingly common in America. In 2018, over 43 million Americans suffered from mental health conditions and 30.4 million persons of all ages were uninsured. The lack of affordable mental health care has had a great hand in the severity of the problem. While there are number of reasons why mental health conditions are affecting so many people, the lack of access to mental health care services and a shortage of affordable providers has been a big cause. To find the root of this problem, first we must look at mental health law in America.

It is true that the number of Americans that have been receiving treatment has increased, the primary reason being the Affordable Care Act (ACA). It is made up of the Patient Protection and Affordable Care Act and its amendment, the Health Care and Education Reconciliation Act of 2010, and it covered mental health under the 10 Essential Health Benefit categories, along with substance abuse disorder services. It amended the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which legally required all large-group insurance plans to cover mental health services in parity with medical/surgical treatment. The ACA expanded parity in mental healthcare for those with plans from individual or small group markets, expanded access

to mental health care and the Medicaid program, and has allowed more Americans to become insured with mental health coverage. The individual impact is also beneficial for those who already had mental health insurance because it became illegal for insurers to write policies that charged higher copays or deductibles for mental health coverage, and they couldn’t set limits on how much they will pay for this care.

But those wishing to receive mental health care services have a more difficult time because insurance companies interpret the claims more rigidly. Many advocate legal groups find that insurance companies can circumvent the parity protection offered by the ACA by imposing strict standards of medical necessity. Oversight by federal and state governments, even when the law allows them to clearly define medical necessity, has given insurance providers the power to exclude or deny mental health coverage. This essentially means that if the insurance company doesn’t deem the client’s mental health treatment as a necessity, which is usually based on their own internal criteria and has the potential to be discriminatory against vulnerable populations.

Since patients have these roadblocks, the conditions of some go untreated, or they attempt to go out of network to receive treatment. For the latter, their average cost-sharing payments increases, which usually leads to patients stopping treatment due to financial concerns before it is complete, or safe to do so. Those who can’t afford it look for other plans, such as Non-ACA-compliant plants that are offered outside ACA marketplaces, which are cheaper. They include short-term plans, association health plans, fixed indemnity plans, and etc. Though their price is lower, the risk is much greater because they usually involve hidden cost and limited coverage, resulting in high medical bills. Thus, a number of factors that prevent Americans from receiving affordable mental health services.

This is troubling since the percentage of adults with a mental illness who are uninsured increased for the first time since the passage of the Affordable Care Act (ACA) this year. Especially now, in the midst of a global pandemic, the mental health of Americans is in jeopardy. A screening conducted by the MHA saw the number of people screening for anxiety increase by 93% between January and September 2020, compared to the statistics from 2019. There was also a 62% increase in those screening for depression. Youth are particularly vulnerable to depressive disorders, and the rates of suicidal ideation are high, especially for LGBTQ+ children. The problem becomes even greater in scale when we take into account the ongoing court case Texas v. United States, where the Supreme Court is deciding on whether it should hear a case which seeks to strike down the ACA’S individual mandate and the fallout could result in millions losing coverage and cost protections. The Trump Administration backed the plaintiffs, so the outcome of the recent US election on the court case could have an impact. That being said, 32