Patients Need to Be Considered Amid Mental Health Equity Federal Rule Decision: Ali Khawar

Ali Khawar, former principal deputy assistant secretary with the Employee Benefits Security Administration, US Department of Labor, emphasizes that patients need to be heard when the Trump administration makes a decision about whether the federal rule regarding the Mental Health Parity and Addiction Equity Act should remain in place.

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

Transcript

What do you think the Trump administration is considering as it makes a decision on keeping this federal rule?

I apologize if this is a nonanswer, but the thing that troubles me more is what it doesn't seem like they're considering. You look at this court filing that they filed about 10 days ago now, and what does it say? It says, "Well, we were sued." I will point out that the lawsuit was arguably cynically filed on the last full day of the Biden administration. We were never actually given an opportunity to even respond to this lawsuit. But putting that aside, the lawsuit was filed by an industry trade association. When you look at that court filing, it talks a lot about the communications that have had been happening between the government and this industry trade association. If that's the voice that they're listening to, a voice that's arguing against better regulation, smarter regulation of mental health parity, a regulation that would make things better for patients, make things better for employers, then let's talk about who's left out of that equation.

There are patients that have mental health needs that work for these employers and who their employers are really trying to do what they can to help. There are family members of those patients. The patient may not, in fact, be the worker. It might be the daughter, the son, the spouse. There are providers, many of whom if you talk to mental health practitioners and you ask them whether they accept insurance, they will most often, [do] what I heard was 1 of 2 things. [They’ll say "Yes,] I do," because it feels like a civic obligation, and there are people that will not be able to afford or access mental health treatment without it, but it's a giant pain, and I kind of wish that I didn't have to. Or they'll say, "I used to," or "Don't," or some form of that, and it's because insurance companies make it way too difficult. "It's too hard for me to get on," or "I used to be on, but I didn't have the staff to handle the massive paperwork burden that the insurance company was putting on me to have to defend every single decision that I made to get any claims paid." I mean, that's not a system that exists because of government regulation.

We like to talk about government red tape and bureaucracy and the compliance burden and all that stuff. That is voluntary stuff that insurance companies are imposing on mental health practitioners, and it's hard to understand why they're doing that other than to cause mental health practitioners to not be part of the network. If you're not part of the network, then what does that mean? That means patients are paying higher costs because they're not getting the mental health treatment that they need, and so the quality of their lives, their productivity, any number of things are worse because they're not getting that treatment. Or they're going out of network, and they're paying out of pocket, and maybe they're getting some reimbursements, maybe they're not, but they just have to get the treatment because they, their loved one, whoever it is, needs to get better, and the only way to do that is by paying out of pocket, and they're fortunate enough to be able to do that.

But those voices don't appear to be part of this decision-making. And really if you're going to be smart about regulating, you can't be listening to just 1 actor in this system. The people who say regulation is bad. You need to also understand why the regulation might be needed, who it would benefit, because part of the process of federal regulation is to understand not just the costs of regulating, but also the cost of not regulating and the benefits of the course of action that you're going to take. The part of what is pretty troubling about this is you don't hear any of that in what the administration is talking about right now.