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Biden administration wants insurance companies to expand mental health coverage


President Biden's administration is accusing health insurance companies of limiting Americans' access to mental health care. Existing law says companies should provide the same access to that as to physical care. President Biden says that's not happening, and he's proposing new regulations to change that. We talked it over with Neera Tanden, who is the president's domestic policy adviser.

NEERA TANDEN: So in 2008, the Congress, in a bipartisan way, passed the Mental Health Parity Act. That law said that essentially, insurance companies, the health care system had to treat mental health care like physical health care. So, for example, you can't be charged $20 to go to a physician and $50 to go to a psychiatrist. However, there have been ways in which insurance companies have avoided the requirements of the law or perhaps evaded the requirements of the law by, for example, having so few mental health providers on their network that essentially it's impossible to access a therapist or psychiatrist, or to have prior authorization requirements, which creates just a lot of friction. So there are just a series of ways in which it is hard to get access to mental health care, even when you're insured.

INSKEEP: I certainly get the concept that an insurance company might just, you know, reject a few extra claims or make it a little more difficult, and that that could be a matter of millions and millions of dollars for them. But the lobbying organization for health insurers identifies a different problem, which does seem to be a real problem. There is a shortage of clinicians and behavioral health professionals. Isn't that the case?

TANDEN: It is absolutely the case that we need more mental health providers. But when you have stories, like the story of a woman whose daughter needed care. She had psychological challenges that she needed specific care for, and she found a mental health provider who was giving her daughter the care she needed. That person wasn't on network. That mental health provider wanted to get on network and really petitioned to enter the network of the woman's insurer. And the insurance company rejected that effort.

INSKEEP: You also hear about mental health providers who are more likely, I think, than other kinds of people who provide health care to be single practitioners or in a very small firm where they don't have the administrative staff to deal directly with health insurance companies. And they will end up being out-of-network instead of in-network. Is that the insurance company's responsibility to work with providers of that sort?

TANDEN: It's absolutely their responsibility to really develop a network of providers. Mental health is a huge challenge in the country. It is also the case that sometimes reimbursement levels can be different for therapy versus physical health care. And that is one of the reasons why, if the reimbursement rate is very low, sometimes people don't want to join that network.

INSKEEP: Oh, they'll say it's not worth the paperwork. It's not worth the trouble because I'm hardly getting paid.

TANDEN: Exactly. But that is the essential problem, which is they should be reimbursed at the same level.

INSKEEP: So you're weighing in with the proposed new rule here. And I'm thinking about the context. You have a U.S. Supreme Court that has twice recently deployed this major questions doctrine, as they call it, to sink big presidential initiatives that have a big political or economic impact. Is the economic impact here large enough that you may need to worry about that at some point?

TANDEN: I mean, I defer to Department of Justice and White House Counsel. I'd say this is very different. The major questions doctrine, as I understand it, is really about whether Congress - whether the executive branch is going beyond...


TANDEN: ...The question that the Congress has posed or has addressed in legislation. I will say very clearly that our rule is realizing the promise and impact of the Mental Health Parity Act.

INSKEEP: White House domestic policy adviser Neera Tanden spoke yesterday as President Biden announced new rules for mental health insurance.


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Steve Inskeep is a host of NPR's Morning Edition, as well as NPR's morning news podcast Up First.