In a previous column, I wrote about the severe impact that mental health-related crisis events have on families, calling it a “crisis within a mental health crisis.” In this column, I return to this topic and write about the challenges of accessing and delivering mental health services. There are likely several areas in the health sector that offer opportunities for bipartisan agreement in the new Congress, including price transparency, site-neutral payments, and pharmacy benefit management. During his first term, President Trump signed legislation expanding community-based mental health services. Another area where bipartisan agreement may be possible is mental health.
A good place to start is by focusing on two issues: access and affordability. These issues negatively impact mental health more than anywhere else in medicine. Many people with mental health problems are unable to find a health care provider or afford the services and medications they need.
This number is a common concern for almost all types of insurance. At least 4 in 10 (43%) insured adults who describe their mental health as fair or poor say they have needed mental health services or medication at some point in the past year; I didn’t understand. Some might think this is primarily a Medicaid issue, but that’s not the case. More than 4 in 10 people in this group have employer coverage (46%), marketplace coverage (45%), and Medicaid coverage (44%). Medicare is doing a little better. Beneficiaries with fair or poor mental health are slightly less likely to report forgoing needed mental health care (27%), which is associated with a higher pattern of elderly care-seeking than Medicare coverage. may be related to.
Overall, this is about four times as many people who report problems with their mental health as very good, very good, or good.
As with almost everything in health care, there are significant racial disparities. Among adults who report fair or poor mental health, white adults (50%) are more likely than black (39%) or Hispanic adults (36%) to say they have received mental health services in the past three years. The tendency is high.
Senators Fetterman and Smith discussed creating a Senate Office of Mental Health earlier this year before the election. commission. Additionally, the Senate Finance Committee released Last year’s bipartisan white paper included a range of mental health policy recommendations.
The commission will need to grasp the multifaceted nature of the problems that people with mental health problems tell us face. For example, 44% of insured adults who didn’t get the mental health care they needed said they couldn’t find a trusted health care provider. 36% said they didn’t know how to find care. And 34% said they were afraid or embarrassed to seek care. More than 4 in 10 people said they were unable to get the mental health care they needed because they couldn’t afford it (44%). 42% said they could not find a health care provider easily accessible for an in-person visit. Just over one-third of insured adults who did not receive mental health care said it was because their insurance did not cover it (37%). The multifaceted nature of this problem means there are many areas that can be improved. This lends itself to the kind of incremental policy change packages that Washington is known for. It also means that there is no single policy intervention that will solve most problems.
If this is a physical medical treatment such as heart disease or cancer, payers will pay for better networks and coverage. Having interviewed hundreds of employers over the years, I know that many employers feel that mental health services could be cost-savings if they were more generous with their mental health coverage. Some simply believe that mental health services are not effective enough.
With that in mind, it’s persuasive that a recent KFF survey found that half (53%) of adults who received mental health services in the past three years said the services were very or extremely helpful. There was. For those most in need, this number fell slightly. Among those who said their mental health was fair or poor, 41% said the mental health services they received were very or very helpful. Still, the majority of those who felt they needed the service said it helped them.
The policy expert in me is cautious about interpreting self-reported mental health conditions, but less precise about what an individual’s mental health problems are. Severe chronic mental illness is very different from anxiety and loneliness. An acute situational crisis is different from a long-term mental illness. The same goes for the self-reported effectiveness of mental health services (how effective is it? How long does it last?).
But as an employer who cares about our employees first and foremost, we want to help people with mental health issues take the sometimes difficult step of seeking help when they think it’s serious. Self-reported levels of effectiveness give me hope. Mental health coverage can be improved. As always, there are challenges and trade-offs. Better coverage means higher premiums, and there is a shortage of mental health professionals, especially those willing to take out insurance, at least at current payment rates. KFF has employees across the country, and it’s not easy for employers to find a plan with a strong network of mental health providers, even if they’re willing to pay for it. 122 million Americans live in officially designated mental health deficit areas.
Mental health parity has been a focus for decades. However, while coverage has improved, it is not substantially equivalent due to prior authorization rules and limited mental health networks. Our KFF survey clearly shows that we are certainly not at par yet. The Biden administration recently announced regulatory updates requiring health plans to have pre-approval rules and networks for mental health on par with physical health, but it remains to be seen how the incoming Trump administration will handle these regulations. It’s opaque.
It’s unclear what aspects of mental health the bipartisan action will carve out. In general, Republicans want to reduce coverage and federal spending, making it highly unlikely that they will address mental health issues overall through more systemic improvements in access and affordability. But aspects of the problem — suicide prevention, support for families in crisis, addressing prior authorization confusion, and other parts of the problem — may be more achievable.
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