Supreme Court’s Chevron Decision Threatens Decades of Progress in Access to Mental Health Care

The recent Supreme Court decision to overturn the Chevron doctrine has cast a shadow over decades of progress towards mental health parity in the United States. The ruling, which limits federal agencies’ power to interpret ambiguous laws, now leaves crucial legislation like the Mental Health Parity and Addiction Equity Act (MHPAEA) vulnerable to court challenges, potentially unraveling years of hard-won progress.

The first serious attempt to establish mental health parity with hospital care came in 1996 with the Mental Health Parity Act (MHPA). The groundbreaking federal legislation required health plans with annual or lifetime limits for medical or surgical benefits to apply those same limits for patients receiving treatment for mental health. 

Unfortunately, its protections were almost immediately circumvented by insurers who began to include limitations on the total number of annual visits or caps on psychiatric hospitalizations. As a result, the law had almost no effect on creating mental health parity.

The next attempt came in 2008. Like its predecessor, the Mental Health Parity and Addiction Equity Act (MHPAEA) had bipartisan support. Unlike its predecessor, the new bill actually required some coverage for mental health. It also recognized the growing crisis in substance abuse and addiction.

However, insurers won a provision allowing plans to apply for temporary exemptions if costs exceeded certain thresholds. Since then, mental health parity has remained elusive. Hospitals needed to solve the cost issue — or plans wouldn’t cover it. Subsequent legislation, including the Affordable Care Act and CMS extensions in 2016, aimed to strengthen mental health parity requirements.

Yet, as a 2019 NPR headline declared, ‘Mental Health Parity’ Is Still An Elusive Goal In U.S. Insurance Coverage. The story observed that many patients “struggle to get insurance coverage for their mental health treatment, even though two federal laws were designed to bring parity between mental and physical health care coverage.”

Now, with the Supreme Court’s decision to overturn Chevron, we face a new threat to progress on mental health parity. Because the implementation of the MHPAEA is left to Congress, it’s now more vulnerable to court challenges. Many in the industry anticipate that insurance companies will seize this opportunity to challenge the MHPAEA, potentially eroding their responsibilities to provide mental health parity. For example:

• Without deference to agency guidance, insurers may challenge what constitutes appropriate parity, potentially leading to more restrictive interpretations. 
• The MHPAEA’s standards for demonstrating compliance, largely defined through agency regulations, are now susceptible to legal challenges.
• The scope of conditions covered under the MHPAEA could face scrutiny. Without agency deference, there’s a risk that courts might narrow the definition of mental health and substance use disorders requiring parity, potentially excluding certain conditions from coverage.

Ultimately, the overturning of Chevron feels like Lucy pulling the football out from Charlie Brown yet again (which, fun fact, she first did in 1956). Every time Congress comes to the table to get something done, the healthcare system, often led by private insurance plans, finds a way to pull the goal out from under us. 

The Chevron decision gives them a powerful new tool to do so, which means we must be prepared to vigorously defend against these potential challenges to ensure patients maintain access to vital mental health services.

Expand access to virtual care 

In light of these challenges, it’s crucial to explore innovative solutions to preserve and expand access to mental health care. For example, a 2021 report from the Substance Abuse and Mental Health Services Administration found strong evidence that telemedicine can be as effective as, or even better than, in-person treatments for mental health and substance use disorders. 

Another study from 2021 on the impact of telemedicine on mental health post-pandemic found that it makes services more accessible by helping patients avoid stigma and receive treatment from home Two recent studies published in NEJM Catalyst came to the same conclusions. 

Make mental health equal to physical health

While it feels like an uphill battle – especially in the current landscape – making mental health equal to physical health and providing public insurance to those who need it would go a long way in our quest to make mental healthcare more accessible and affordable. As long as it remains separate and a challenge to diagnose and treat like physical health, we will not achieve the levels of access desperately needed for Americans of all ages. 

Address the social determinants that play a role in mental health

Things like poverty, where someone lives (e.g., rural vs. urban) and systemic marginalization can significantly impact a person’s mental health. We need to start long before someone shows up in our offices or emergency rooms with acute mental health issues, and focus on what we can do locally – e.g., in communities and schools – to prevent those kinds of serious issues.

The fight for mental health parity in the U.S. has been long and challenging. The Chevron decision adds a new hurdle, but it also underscores the urgent need for action and innovative solutions. Approximately one in five U.S. adults experience mental illness each year (1 in 20 experiences serious mental illness), so the time is now to ensure more consistent access to quality care is available to every American.

Photo: Flickr user Matt Wade

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