A decade after Congress passed its Mental Health Parity and Addiction Equity Act, states are falling short of enforcing protections for mental health and addiction treatment access for patients, said former congressman and mental health care advocate Patrick Kennedy.
Want proof? Just look at the nation's opioid epidemic, he said.
"Even in spite of the fact that we're in the midst of the biggest public health crisis of our time of overdose and suicide, we as a nation have yet to come to grips with this in the way that it needs to be," Kennedy said.
Even as major steps have been taken in recent days and months to put resources toward addressing the public health crisis—including the package of bills signed into law by President Trump last week—Kennedy said he is seeking to stir up a new fight across the nation for improved access to addiction services and mental health care.
Calling the campaign "Don't deny me," Kennedy said he is trying to create a movement of patients pushing back against insurance denials for mental health and addiction care that should be covered under the decade-old parity law he once championed. That law, the Mental Health Parity and Addiction Equity Act of 2008, requires health insurance carriers to achieve coverage parity between coverage for mental health and substance use disorders and medical and surgical benefits.
"Too many people are still shamed by their illness and reticent to report a denial," Kennedy said. "The persistence of the shame around this illness is our greatest enemy, and if we can tackle that by framing this as not a judgment on mental illness and addiction but rather a judgment on the response to this illness, I think we free people to be more vocal."
Announcing the campaign earlier this month, Kennedy said he is trying to launch a societal conversation about mental illness, while also giving patients a central place where they can register their insurance denials on its website. As part of the launch, The Kennedy Forum also released report cards for each state grading their mental health care policies.
"The overall goal is to get a group of passionate and articulate folks who've been denied access to care because of their mental illness or addiction, to expose the discrimination of their denial," he said.
Once enough people have shown that there are certain patterns of denial that run consistently across the same health plans within each state, advocates can meet with attorneys general in each of the 50 states to push for investigations of the problem, he said. "And then of course, we get political and we go to the state legislatures and say, 'How can you allow a payer to contract the state business for state employees, some of the most lucrative contracts across the country for these big insurers, when they have clearly demonstrated a lack of parity and are essentially in violation of the law,'" Kennedy said. "That is the end game. If we are able to do that, I think payers are going to stand up and take notice."
In the midst of these shortcomings in mental health care delivery, the U.S. has seen an ongoing rise in so-called deaths of despair including those from drug abuse and suicide, he said. The Centers for Disease Control and Prevention estimates there were 72,000 deaths from opioid overdoses last year and more than 43,000 suicides reported in 2017. In a bit of positive news, the CDC recently released preliminary data which may show those deaths have begun dropping and may have peaked.
"There are still tons of roadblocks on the policy side and, frankly, in spite of the fact Congress thinks they've appropriated some gargantuan amount of money, it still represents less than one-fifth of what we were spending on HIV/AIDS during the AIDS crisis when we were losing far fewer people than we're currently losing today," Kennedy said. "This thing is staggering in its scope and yet we still fail to rise to the challenge of this epidemic."
Policies need to be passed to maximize individuals' access to treatment and optimize their recovery from both mental illness and addiction. But really, he said, the federal law simply needs to be enforced as it is written.
"If it is properly enforced, it would be enforced on both Medicaid plans and those plans required under the ACA to have mental health and addiction as an essential benefit where what is on paper doesn't always get applied in reality," Kennedy said. "It will force the issue because it's a liability now on the part of payers including private insurers as well as employers. We need to build an advocacy movement."