The Biden administration joined the vigorous debate this week about why millions of Americans who have a mental illness still aren’t getting help — and put the blame squarely on health insurers. But the insurers say the real reason is a dearth of clinicians trained to treat people for conditions like anxiety and depression. Biden’s case: In introducing new rules for insurers, White House domestic policy adviser Neera Tanden argued that insurers deliberately make it hard for their s to access mental health care from providers who take their insurance, forcing patients to pay out of pocket. She said insurers do this by failing to establish adequate networks of mental health providers, forcing patients to seek treatment out of network. Additionally, the administration accuses insurers of often requiring clinicians to obtain prior authorization for treatments, or otherwise putting up roadblocks for patients seeking mental health care. The American Medical Association, the leading professional society for doctors, backs the White House’s assessment. The administration’s proposed rules would require insurers to set up networks and coverage-decision mechanisms for mental health care that are equivalent to those for physical health. Insurers respond: Kristine Grow, spokesperson for AHIP, the lobbying organization for health insurers, acknowledged the difficulty some patients have in obtaining mental health care but said the problem is rooted in the clinician shortage. The insurers cite data from the health research group KFF that 47 percent of Americans — 158 million people — live in a mental health workforce shortage area, as defined by the Department of Health and Human Services. That makes it hard to maintain robust networks of providers, she added. Grow said insurers are nonetheless working hard to expand their networks and using tools like telehealth to reach patients in care deserts. She cited a 108 percent increase in claims for behavioral health from 2007 to 2017, as detailed in a report from FAIR Health, a nonprofit that examines health insurance claims, as evidence that those efforts are paying off. Republicans have the insurers’ backs. House Education and the Workforce Chair Virginia Foxx (R-N.C.) said the Biden rules were overly burdensome and meddled inappropriately in the insurance business. She said the rules would backfire by imposing “hundreds of millions of dollars in additional costs on businesses, increase premiums, and run the risk of encouraging plans to create more barriers to medical care.” What’s next? The administration hasn’t yet released the text of the regulations. Once it does, they’ll be open for 60 days of public comment, after which they could be finalized.
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