Tucked in the president made Tuesday on the opioid epidemic was his announcement of a new 鈥� aimed at ensuring that people with mental illnesses and substance abuse problems don鈥檛 face discrimination in the health care system.
Despite a landmark intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.
鈥淭he goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it鈥檚 actually enforced, that the concept is not just a phrase 鈥� an empty phrase,鈥� President 聽Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. 鈥淲e鈥檝e got to let the insurance carriers know that we鈥檙e serious about this.鈥�
Advocates say parity has long been an 鈥渆mpty phrase鈥� and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.
鈥淚t鈥檚 better late than never, and you can鈥檛 not be grateful for the fact that we鈥檙e finally implementing a law that was passed nearly a decade ago,鈥� said former congressman Patrick Kennedy, one of the authors of the parity law. 鈥淏ut it鈥檚 troubling that it鈥檚 occurring in the last year of the presidency, and that it took the administration this long to address a problem that鈥檚 been with us for many years.鈥�
In by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed 鈥渘ot medically necessary鈥� twice as often for mental health as for other medical conditions. Only and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as last year.
For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.
鈥淓ven this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they鈥檙e afraid to step on the insurers鈥� toes,鈥� Kennedy said.
Tuesday鈥檚 announcement, he said, was also meager. 鈥淚f the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.鈥�
Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were for patients with coverage under Medicaid and the Children鈥檚 Health Insurance Program (CHIP).
Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.
鈥淥ur industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,鈥� Clare Krusing,聽a spokesperson for America鈥檚 Health Insurance Plans, the industry鈥檚 main trade group, said in a written statement. 鈥淪uggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country鈥檚 health system for those who need behavioral health care.鈥�
The interagency task force, which will be chaired by the White House鈥檚 , will aim to identify and promote best practices for state and federal agencies to ensure that 聽insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.
鈥淚 think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,鈥� said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.
People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be 鈥渒eenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.鈥�
Provider groups widely applauded the creation of the task force.
鈥淲hat we鈥檙e hoping is that the task force will increase the visibility of the issue and highlight its significance,鈥� said Dr. Ren茅e Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.
鈥淲e would welcome the opportunity to meet with the task force as part of its outreach charge,鈥� she said.
But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be 鈥渢oo little, too late.鈥�
鈥淚t鈥檚 simply not enough to have mental health parity 鈥� even with this change in law, there will still be access issues for patients.鈥�
That鈥檚 because mental health providers often don鈥檛 have appointments readily available or won鈥檛 accept these patients鈥� insurance coverage, he said.
鈥淲hile mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,鈥� Miller said.