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President Biden endorses plan to expand mental health care

STEVE INSKEEP, HOST:

If you break your arm, you go to the doctor. And if you have insurance, they would usually pay. Many people report a much harder experience when they seek mental health care.

LEILA FADEL, HOST:

It's hard to find treatment in-network and hard to get insurance to pay. President Biden yesterday said health insurance companies are not fully following the law. He's proposing new regulations that would push companies to try harder and pay up.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT JOE BIDEN: You get referrals to see mental health specialists, but when you make the appointment, they say, I can't see you until your doctor submits the paperwork and get special permission from the insurance company. Give me a break.

INSKEEP: NPR's Yuki Noguchi was listening to the announcement yesterday and is on the line. Good morning.

YUKI NOGUCHI, BYLINE: Good morning, Steve.

INSKEEP: What's the White House trying to do?

NOGUCHI: It's trying to strengthen existing policies that are already in the books, and it wants to do so by closing loopholes that have left patients with too few options for mental health care covered by insurance. And, you know, historically, insurance didn't cover care like therapy the same way it did physical care, like surgery. And a landmark 2008 law tried to change that, but insurers found ways around it. For example, it might appear as though an insurer has a network of mental health professionals, but in fact, many of them might not be taking new patients or are no longer practicing or are too far away. Or sometimes insurers would require paperwork to authorize treatment repeatedly in order to keep getting treatment. So some families told me the reauthorization could be almost daily.

INSKEEP: OK, so the principle here, the law is you're supposed to have equal access to mental...

NOGUCHI: Yeah.

INSKEEP: ...Health care, equal to what you would get for your physical health.

NOGUCHI: Yeah.

INSKEEP: What are people doing when instead they find these barriers?

NOGUCHI: Well, you know, it's a really crisis situation in a lot of cases. And if you don't have insurance, it's a huge cost, right? Paying out of pocket for something like inpatient treatment can easily cost $100,000 or more. So even families with resources often end up tapping every source of cash and credit they can, like this Michigan woman, Rachel, who last year described the situation paying for her son's treatment.

RACHEL: All of our savings is gone. How are we going to send our kids to school? How are we going to - like, what are we going to do when it's time for, like - how are we going to recover from this? I don't know. Those thoughts in your mind - like, there's no space for that when you are just trying to keep your child alive.

NOGUCHI: You know, and Steve, out of desperation, some families even impoverished themselves to qualify for public insurance like Medicaid, and some forgo care and let conditions worsen into a bigger crisis or end up in the ER.

INSKEEP: But all of this is happening under an existing 15-year-old law, as you mentioned, that I know has also been updated more recently. So what has the White House proposed to do about that?

NOGUCHI: Well, it's trying to address the fact that there's not a lot of good data or even clear definitions to track how these policies affect patients. So it really hasn't been possible to hold insurers accountable. And the White House also wants better reimbursement for the doctors and therapists who provide this care. And the hope there is that maybe that will draw more people into the profession.

INSKEEP: Oh, that's what I would have assumed was part of the problem is just not enough mental health care providers to go around.

NOGUCHI: Yeah, absolutely, right? At a time when mental health crises are really on the rise, you know, there aren't enough professionals to take care of them. And that's something that's going to take a lot of time to solve. And even the president acknowledged that, you know. While with these policies, he wants to address insurance problems, there are still lots of problems with access to care generally.

INSKEEP: NPR consumer health correspondent Yuki Noguchi, thanks so much.

NOGUCHI: Thank you, Steve.

INSKEEP: And since we've raised mental health, let's mention this. If you or someone you know is in crisis, call or text 988. Three numbers - 988 for the National Crisis Lifeline. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.
Steve Inskeep is a host of NPR's Morning Edition, as well as NPR's morning news podcast Up First.
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