Mental health parity – the notion that insurers treat mental and physical health care equally – was already difficult to enforce. Now, it faces new obstacles. A May 9 court filing signaled that the Trump administration will not enforce a Biden-era regulation that was enacted last fall.
The rule aimed to require stronger compliance with the 2008 Mental Health Parity and Addiction Equity Act, ensuring that “material differences” in coverage or costs did not prevent patients from accessing care. To that end, the rule required that corporate health plans and insurers report how they are covering mental health conditions, with the goal of ensuring patients with mental health conditions have the same access as those with physical health conditions.
Legal Challenge Triggers Regulatory Retreat
The reversal came in response to a lawsuit filed by a national employer group against the Department of Health and Human Services.
The group objected to new requirements issued in September 2024, which directed insurers to provide evidence of employees’ ability to access mental health care, citing high compliance costs that impinge on affordable care. In the May filing, the Trump administration said the rule would not be enforced while the litigation proceeds.
If the lawsuit succeeds, the federal government may rescind the guidance altogether. If so, insurers would face fewer statutory requirements to fully cover mental health care. In the absence of such pressure, historical evidence indicates plans are less willing to provide mental health benefits, leaving patients navigating high copays, prior authorization hurdles and increasingly confusing provider networks.
Increasing Need for Mental Health Help
The timing of this change is especially troubling, as 90% of U.S. adults believe that the country faces a mental health crisis.
Demand for mental health care has reached new highs, driven by increased rates of anxiety, depression and substance use disorders, especially since the COVID-19 pandemic and lockdowns. Even fully insured patients often encounter restrictive networks, limited reimbursement and higher out-of-pocket costs when seeking mental health treatment.
Without regulatory enforcement, insurers may revert to old patterns of offering nominal coverage on paper while limiting meaningful access in practice. The 2024 rule was designed to change that by holding insurers accountable and requiring proactive reporting. Its rollback risks widening the gap between mental health needs and available care.
Future of Mental Health Access Uncertain
Advocates praised the 2024 rule as a long overdue course correction. Its uncertain future has now reignited concern about whether parity can be achieved without sustained oversight. As the legal battle unfolds, patient advocates face growing urgency to safeguard mental health access in the face of shifting regulatory winds.
The U.S. Departments of Labor, Health and Human Services and the Treasury acknowledged insurers’ concerns about the implementation of the law, but affirmed, the “Departments remain committed to ensuring that individuals receive protections under the law in a way that is not unduly burdensome for plans and issuers.”
