Codifying the Mental Health Parity Federal Rule May Not Be on the Table: Ali Khawar

Ali Khawar, former principal deputy assistant secretary with the Employee Benefits Security Administration, US Department of Labor, explained that, although repealing of the federal rule regarding the Mental Health Parity and Addiction Equity Act (MHPAEA) would be detrimental to equity in care, it's unclear whether Congress would attempt to close this gap.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

Do you think Congress will take action to clarify the MHPAEA if the federal rule is overturned?

There are warring aspects in my mind right now. The optimist in me wants to remind you that it wasn't just the Mental Health Parity and Addiction Equity Act, which was passed in 2008 on a bipartisan basis. It goes back. You can look at the Mental Health Parity Act itself, which was its predecessor, that was passed on a bipartisan basis. MHPAEA itself has been strengthened over the years, most recently in the Consolidated Appropriations Act of 2021, which President [Donald J.] Trump signed into law. That contained additional requirements for health plans to prove that they were operating in compliance with mental health parity; it contained additional tools for the department to look at mental health parity; additional resources. That was also done on a bipartisan basis. If you look at the first Trump administration, if you look at successive Democratic and Republican presidential administrations, and you look at successive either Democratically controlled or Republican controlled Congresses, you find a history of bipartisan action on this space.

Now we're at a particularly, perhaps unique moment in history. Because it's not just the repeal or the walking away from mental health parity. You also have really significant budget cuts and other issues happening at SAMHSA [Substance Abuse and Mental Health Services Administration] and the National Institutes of Mental Health. I mentioned earlier that the mental health parity work was one piece of a broader puzzle, one strategy to address this unity agenda around mental health. And when you look at some of the other work that was happening, it was a significant amount of money used to fund school counselors to help with student mental health, which was really, really acute needs there. It was training programs to get more people into the pipeline.

One of the things that you hear time and time again from opponents of the work that we did is that really the problem isn't lack of compliance with mental health parity, it's that there's just not enough mental health therapists, psychiatrists, psychologists, fill in the blank. And my answer to that is, where are those individuals protesting the cuts to the federal money that was used to address that very problem? It's also true that when you look at the kind of violations that we're seeing, having a plan document or an insurance policy that says you don't get access to nutritional counseling if you have an eating disorder, but you get it if you have diabetes, that's not being driven by a shortage of mental health professionals. There's a lot of compliance work that needs to happen before the problem that you're dealing with and the insurmountable obstacle that you're dealing with is a shortage of mental health professionals. We're just not there when it comes to compliance.

But putting that aside, there was a lot of federal government efforts that were happening that are now being paused, undone, abandoned, that were part of a broader tapestry to address this need. And if you don't have that work, and you're walking away from mental health parity regulation, and you're walking away from mental health parity enforcement, these are all really, really troubling signs about what the future holds. We shouldn't live in a society where it matters whether you have a mental health condition or a physical health condition. That shouldn't be determinative of whether we think that you're worthy of help, worthy of protection under the law. What we're talking about with this announcement, on the heels of all the other announcements, is a universe where that's the reality, and it was the reality for many people with mental health conditions and addiction conditions for a long time. That's not the kind of society that I think we should be moving towards. We shouldn't be, in part, because it exacerbates the stigma that people face, it makes them less likely to seek treatment, and if they're not seeking treatment, they're not able to access treatment, they're going to be worse off. You're going to have a less productive economy. You're going to have a less productive workforce. All of those ripple effects are very troubling.