Mental health is health: President Biden pushes to have all care treated the same by insurance carriers

Mental health parity has been a political applause line for more than three decades. And it's been federal law since 1996, when President Bill Clinton signed the Mental Health Parity Act, a statute whose obligations were reiterated, expanded and refined in the 2008 Mental Health Parity and Addiction Equity Act. But it is yet to be a reality in the lives of millions of Americans, who, grappling with complex rules written by private insurers, still far too often struggle to obtain the affordable, high-quality psychological and psychiatric help they need, when they need it. Indeed, the disparities in access are only widening in recent years.

To the rescue, he hopes, comes President Joe Biden, with a proposed federal rule aimed at health insurers. It would demand health plans evaluate the real-world effects of their coverage rules to be sure that mental health and medical benefits are equivalent; demand plain-language explanations with specific examples of what health plans will and won't cover; and close loopholes in order to ensure the federal parity law reaches another 200 health plans covering nearly 100,000 additional Americans.

Assuming it all takes effect, Americans will soon enough be able to gauge for themselves whether they feel the difference in a meaningful way.

Even before then-Second Lady Tipper Gore, who went public with her struggle with depression, equalizing access to mental health care has been an easy cause for the powerful to champion. New Yorkers remember well how then-First Lady Chirlane McCray talked up the billion-dollar ThriveNYC, which said many of the right things but did far too little to ensure people on the ground — and especially the most seriously mentally ill — get timely help, including, in some cases, court-ordered outpatient or even in-patient treatment plans.

The disconnect remains. Not only do families need far easier access to psychologists and psychiatrists to get early and consistent help for depression or bipolar disorder or eating disorders or ADHD or whatever else they may be struggling with, but government and medical providers need stronger tools to ensure that the most seriously mentally ill on New York City's streets, disconnected from support networks, get treatment for the psychoses that plague them. Any mental health parity agenda that addresses one without the other is incomplete.

That's why it's long past time for Congress to end the "IMD exclusion," a federal law prohibiting Medicaid payments for any "institutions of medical disease," which means any "hospital, nursing facility or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services." A provision intended to stop the warehousing of people in asylums has wound up cutting off the flow of federal funds to people in the throes of crippling psychological conditions.

Ailments afflicting the mind are no less serious or worthy of care than those afflicting the body. Indeed, it may well be that authorities have even more reason to ensure treatment is provided in the former case, for all too often people suffering from serious psychological conditions are unaware that they need help. In those cases, it takes a concerted effort by friends of family members, or by the doctors and courts, to ensure that help reaches them.

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