Healthcare leaders across the U.S. are raising concerns after federal agencies shared intentions earlier this month to significantly revise the Mental Health Parity and Addiction Equity Act. Industry stakeholders say the decision could weaken enforcement, exacerbate access challenges and widen disparities in behavioral healthcare at a time of rising demand.
Seven behavioral health executives shared their reaction to a recent policy development related to the Mental Health Parity and Addiction Equity Act.
Editor’s note: Responses have been lightly edited for clarity and length.
Sheryl Bates. Director of Mental Health Crisis Access and Utilization Management for Endeavour Health (Evanston, Ill.): The 2024 rule represented the most substantial update to parity regulations in nearly a decade, reinforcing requirements for insurers to evaluate and justify limitations on mental health and substance use disorder services. It emphasized transparency, requiring comparative analyses of nonquantitative treatment limitations. The administration’s decision not to defend the rule introduces uncertainty and delays stronger enforcement. Oversight and accountability are already difficult and this may weaken it further.
Access to care is already a challenge across the country and decisions like this create further risk of it getting worse.
- Short-term: Likely continuation — or worsening — of existing barriers such as higher denial rates, restrictive authorization processes, and delays in accessing behavioral health services.
- Operational impact: Health systems may face ongoing administrative burden navigating inconsistent payer requirements, limiting efficiency in care coordination.
- Equity concerns: Without stronger enforcement, disparities between physical and mental health coverage will persist, disproportionately affecting vulnerable populations.
- Long-term risk: Delayed regulatory clarity may slow progress toward true parity, potentially reducing timely access to critical mental health and substance use treatment.
Overall, this decision will stall momentum toward equitable behavioral health access at a time of increasing demand, placing greater strain on providers and patients alike.
Dominique Dietz. Director of Virtual Behavioral Health at OSF HealthCare (Peoria, Ill.): Since 2020, mental health challenges have intensified. In 2024, over 60 million U.S. adults (about 23%) experienced a mental illness, yet nearly half did not receive treatment (Mental Health America, 2025; HRSA Behavioral Health Workforce Brief, 2025). More than 14 million adults reported serious thoughts of suicide, underscoring the severity of unmet need (Mental Health America, 2025). As the APA emphasizes, the intent of MHPAEA is to eliminate barriers and not allow them to persist.
According to the Heart of Illinois United Way Community Health Needs Assessment, our area reports mental health as one of the top three needs. Fifty-nine percent of the adults surveyed noted that they did not speak with someone about their mental health due to lack of insurance coverage, not able to locate services, unable to afford the copay or too long of wait times.
These realities highlight a critical point, parity exists in law but not yet in practice. At a time of growing need, policymakers should strengthen not scale back parity enforcement. Ensuring equitable access to mental health care is essential to improving outcomes and addressing one of the most pressing public health challenges in the United States.
R. John Repique, RN. Director of Behavioral Health at Augusta Health (Fishersville, Va.): With the federal government’s recent announcement that it would rewrite the 2024 Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule rather than defend it in court, essentially, it is déjà vu of the “pre-2024 framework.” While the 2008 underlying law remains, the 2024 updates required insurers to provide objective data on network adequacy and reimbursement. For now, enforcement returns to a “pre-2024″ leaving a massive gap in accountability. This isn’t just a regulatory shift; it’s an unnecessary pivot that will only fuel the access crisis in some geographically disadvantaged areas.
The 2024 rule was designed to close loopholes that allow “ghost networks” and arbitrary prior authorizations to flourish. By stepping back from these standards, the federal government has effectively shifted the burden of proof from the insurer to the provider and the patient. Here in Virginia, where we’ve made historic investments in behavioral health transformation (like the Right Help, Right Now initiative), these federal headwinds threaten to erode our progress.
Nowhere is this more dangerous than in rural Virginia. Our rural clinics already battle razor-thin margins and severe workforce shortages. If parity enforcement weakens:
• Rural BH providers /clinicians may stop accepting commercial plans that offer inadequate reimbursement compared to medical peers.
• Delayed Care = ED overcrowding: When “narrow networks” force patients to travel hours for a psychiatrist, they often wait until they are in a full-blown crisis, flooding our already-strained EDs.
• Economic Strain: Uncompensated care rises for community hospitals when insurance barriers prevent outpatient stabilization.
Virginia cannot afford to wait for a federal rewrite that may take years. With the General Assembly’s recent passage of HB 656, we have a roadmap to codify stricter state-level network adequacy and reporting.
To protect our rural infrastructure, we must prioritize:
Strict State Enforcement: Utilizing the Bureau of Insurance to compel the same data that the federal government has abandoned.
Rural-Specific Reimbursement: Ensuring that parity accounts for the increased costs associated with providing care in “healthcare deserts.”
Transparency: Publicly tracking denial rates by zip code to identify areas where parity is failing in real-time.
Parity shouldn’t be a “ZIP code lottery.” If the federal guardrails are coming down, Virginia must build its own.
Michelle Schafer. CEO of Mental Health Cooperative (Nashville, Tenn.): As someone who has spent their entire career in the Mental Health and Addiction Field, I strongly support efforts to strengthen and clarify parity protections. It is well researched and documented that mental health is a key component of an individual’s overall health. For far too long, individuals seeking mental health and substance use treatment have faced barriers that would be unacceptable in any other area of healthcare — whether through limited provider networks, restrictive prior authorization requirements, or inconsistent coverage standards. True parity is not just about fairness in benefits on paper; it is about meaningful, timely access to care in practice.
Clearer federal guidance and stronger enforcement mechanisms are essential to ensure that health plans treat mental health and substance use services with the same urgency and rigor as physical health conditions. When parity is enforced effectively, we see earlier intervention, improved outcomes, and reduced long-term costs for individuals, families, and communities.
At a time when the demand for behavioral health and substance abuse services continues to grow, strengthening parity is one of the most impactful steps policymakers can take to expand access, reduce stigma, and support whole-person health. I’m encouraged to see federal agencies revisiting these rules and hope the final regulations create accountability that translates into real-world change for patients and providers alike.
Arpan Waghray, MD. CEO of Providence’s Well Being Trust (Oakland, Calif.): I have seen how access, or lack of access, to timely mental health and substance use care can profoundly affect a person’s life. For that reason, I am hopeful that efforts to issue new proposed rules related to the Mental Health Parity and Addiction Equity Act will lead to further strengthening this law in ways that honor its original purpose: ensuring equitable insurance health plan coverage for mental health and substance use disorder care that is comparable to medical and surgical coverage.
Although the 2008 law established an important foundation, gaps between policy and practice persist, with real consequences for patients and families seeking care during vulnerable moments. Strengthening and clarifying parity requirements is a critical opportunity to close these gaps and improve meaningful access to care.
Through partnerships with organizations such as The Kennedy Forum, Providence’s Well Being Trust remains committed to transforming the mental health and addiction systems in the U.S. Ultimately, these conditions are medical conditions, and strengthening parity brings us closer to ensuring people can get the help they need to heal and flourish.
Jesse Tamplen. Vice President of Care Coordination and Continuous Performance Improvement and Executive Administrator of Behavioral Health at John Muir Health (Walnut Creek, Calif.): I support the American Psychiatric Association’s call for strong mental health parity protections and believe the decision by federal agencies not to defend the 2024 final rule on the Mental Health Parity and Addiction Equity Act raises serious concerns about access, equity, and accountability across the U.S. healthcare system.
The 2024 final rule, building on the original 2008 law and subsequent federal requirements, includes critical mechanisms that determine whether patients and families receive quality-of-life-improving mental health care or lifesaving treatment. Today, children and adolescents in the United States often face delays of up to 8-10 years from symptom onset to mental health treatment, a gap that, if the 2024 rule is weakened, will only deepen barriers to timely, necessary care.
Weakening or failing to enforce parity requirements will move us further away from whole-person, integrated care and deepen a fragmented system that treats mental health differently than any other medical condition, reinforcing stigma and leading to more patients experiencing delays or going without critical behavioral healthcare.
Health systems, physicians, and outpatient providers across the country are already under significant strain. When patients cannot access timely behavioral health care, they are left waiting in crisis, often in care settings not designed to meet their needs, such as emergency departments. At the same time, families search for answers while providers operate within an already stretched system with limited access to treatment. This directly impacts patient outcomes, workforce sustainability, and the ability of health systems and physicians to meet the needs of the communities they serve.
As rulemaking moves forward, the path must be clear: strengthen parity enforcement, protect access, and support health systems and providers in delivering high-quality, coordinated care. Ensuring equitable access to behavioral health services is essential to advancing health, improving outcomes, and sustaining our healthcare system and the health of our communities.
Robert Trestman, MD, PhD. Chair of Psychiatry and Behavioral Medicine at the Virginia Tech Carilion School of Medicine (Roanoke): The fact that the government has chosen to withdraw from defending this lawsuit is a very disheartening decision. Defending and reinforcing the implementation of the Mental Health Parity and Addiction Equity Act (MHPEA) remains a key tool in achieving meaningful health equity.
Mental health and substance use disorder treatment parity continues to be a challenging, if not elusive, goal over 18 years since the law was enacted in 2008. The fact that MHPEA has virtually no significant financial consequences for its violation is one of the primary issues we struggle with in the day-to-day reality of providing care to populations in need when insurers are essentially free to behave in ways that discriminate against our patients.
I am concerned that the announced revision of the rules by HHS, Treasury, and the Labor Department may further restrict our ability to hold insurance companies accountable for treating patients with mental illness and substance disorders equitably to those with other medical or surgical concerns. This decision to withdraw from the lawsuit does not bode well.
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