Policy News Roundup: October 31, 2024

Broad support for mental health parity law

A West Health-Gallup poll found that the Mental Health Parity and Addiction Equity Act (MHPAEA, or Parity Act) has broad public support.

• The Parity Act requires insurance companies to provide coverage of mental health and substance use disorder care that is equal to coverage of medical care for physical conditions. The federal government just finalized new rules to increase compliance.

The findings:

• Majorities of adults across the political spectrum support the law.
• The recent updates to MHPAEA align with public opinion, but many Americans are skeptical that insurance companies will comply.
• Even with MHPAEA in place, most Americans believe the government should be doing more to ensure access to care and are generally pessimistic about improvement in the near future.

The specifics:

• Nearly 4 in 5 Americans either strongly (48%) or somewhat (31%) support the federal parity law, including 95% of Democrats, 79% of Independents and 67% of Republicans. There is nearly unanimous support among Democratic men and women, but among Independents and Republicans, women are more likely to say they support the law.
• Half of Americans say they have little to no trust that insurance companies will comply with the federal law.
• More than 7 in 10 believe the government is not doing enough to ensure the public has access to mental health care (87% of Democrats, 73% of Independents, 57% of Republicans). Women are more likely than men to express dissatisfaction (among Republicans and Independents).
• 6 in 10 say it is “not very likely” or “not likely at all” that access to affordable mental health care in the U.S. will improve in the next 5 years.

Our thoughts: The same as most Americans’.

• We strongly support the federal parity law, are concerned insurance companies will continue to skirt requirements without more enforcement, and think much more is needed to ensure access to affordable care.

Source: Bipartisan Support for Improving Mental Healthcare Access (Gallup)

The Big Cities Health Coalition polled residents in its member jurisdictions about how government should address issues.

The findings: The results show broad support for a public health approach to problems facing cities and for increased investment in those solutions.

The specifics:

• 7 in 10 city residents think a public health approach is the right way to tackle issues of homelessness and drug use and improve the overall wellbeing of their city.
• Two-thirds or more say that unaffordable housing, high inflation and cost of living, and the mental health crisis are each main or big causes of crime, substance use and homelessness.
• 6 in 10 think their city does not invest enough in services and programs that save lives and improve health (53% agree for addiction and overdose, 62% for homelessness).

Why it’s important: The public understands the links between addiction and issues including mental health, homelessness and poverty and the need to address the underlying issues. These findings can help support policies that move away from a punitive and towards a public health response.

The recommendations: The research points to:

• Recommendations for messaging: Leaders should acknowledge residents’ views that cities are facing a multipronged crisis. They should use arguments that match residents’ support for a public health approach and the need to provide people who are struggling with opportunities, rather than focus on crime. They should also share specific examples of how prioritizing the public health approach yields both short-term impact and long-term solutions and turn the need for public investment into a rallying cry.
• Effective responses to the criticism that harm reduction “enables” drug use: Harm reduction treats people who use drugs as people, rather than criminals. Harm reduction ensures immediate access to evidence-based strategies for reducing overdoses and other harm as cities rally the resources to fund housing and the full scope of supportive services needed long term.

Source: City residents support public health approaches to drug use, homelessness: a messaging playbook (Big Cities Health Coalition)

Current and former members of the Rhode Island Opioid Settlement Advisory Committee wrote a commentary on how to spend the opioid settlement funds.

Rhode Island: Rhode Island has quickly gotten money out the door, investing transparently in evidence-based prevention, treatment, recovery and harm reduction programs.

But: There are still many challenges, and many states have been slow to distribute funds and are putting them toward ineffective strategies.

Lessons learned from Rhode Island and other states:

1. Accountable distribution of money is only the first step; governments must also accurately design requests for proposals, ensure efficient procurement systems, evaluate programs effectively and streamline execution of funding ideas. Bureaucratic processes can be difficult for small organizations to navigate, so it is important to invest in capacity-building and support grassroots organizations.
2. Throwing money at the problem cannot be the only strategy. Settlement funding needs to be paired with meaningful policy changes that rebuild the social safety net, address the housing and affordability crises and provide economic opportunities to people with addiction.
3. Addressing the racial/ethnic inequities in access to prevention, treatment and harm reduction services must be at the forefront of every opioid settlement funding decision.
4. Settlement funds must be leveraged to address the rapid increase in stimulant-involved overdoses, particularly in Black and Hispanic/Latino communities. This includes supporting treatment programs for stimulant use and culturally tailored, multilingual outreach to communities of color to increase access to harm reduction.

What else is needed: Engaging community stakeholders, increasing reimbursement rates, expanding workforce development and using settlement funds to train more health care professionals in addiction and maintaining/expanding policies that reduce barriers to treatment.

Source: How to make sure opioid settlement money isn’t wasted (STAT)

Law firms filed a class action lawsuit this week against Anthem Blue Cross Blue Shield taking aim at ghost networks for mental health care.

• The lawsuit claims the insurer published an inaccurate directory of mental health providers accepting coverage.

The details:

• The two plaintiffs were insured through Anthem when they say they tried unsuccessfully to use its online directory to find in-network providers. They found multiple instances in which providers were listed with inaccurate phone numbers, did not practice in the specialties listed or did not accept Anthem insurance. They turned to out-of-network providers and received little reimbursement.
• The lawsuit alleges the network flaws violated a section of the No Surprises Act, a surprise billing law that establishes provider directories exist to insulate consumers from large, unexpected medical bills.
• It also claims violation of the federal parity law and New York consumer protection law that requires insurers to keep their directories up to date within a month.

Study findings:

• Attorneys for the plaintiffs did a “secret shopper” study and found that only 7 of 100 doctors accepted the plaintiffs’ plan.
• Of those, several were not accepting new patients or had an 18-month wait.

The bigger picture: The lawsuit comes as Congress and the White House are stepping up efforts to address ghost networks and bolster network adequacy and directory accuracy.

Why it’s important: It is difficult to find and access affordable care with inadequate insurance coverage and inaccurate provider directories. For more, see our recent PNS story: Ghost networks trap patients

Source: Lawsuit says “ghost networks” are denying Americans mental health care (Axios); ‘Ghost Network’ Class Action

The Drug Enforcement Administration (DEA) and epidemiologists who study substance use say “pink cocaine” has become a dangerous and increasingly popular part of the club scene in U.S. cities.

What is it? Pink cocaine, aka tusi, is made up of a revolving group of drugs.

• Most samples of it contain at least one stimulant drug and one depressant. Often, it includes ketamine and other drugs like ecstasy, methamphetamine, opioids and bath salts.
• It rarely contains cocaine, however.

Then why is it called “pink cocaine”? The name likely comes from the fact that it is sold in powder form and dyed pink with food coloring.

• The other name, “tusi,” is from its origins in Colombia as the synthetic compound “2C,” a quasi-psychedelic. But it rarely contains that substance either.

Where is it coming from? Last month, the DEA said the distribution of pink cocaine was increasing and that it was mostly sold online and through social media.

• It also said that the Sinaloa Cartel was increasingly manufacturing and trafficking the drug.

What makes it dangerous?

• The concoction can cause dissociation and amnesia and has been used in date rape cases.
• Dealers and users rarely know what is in any given batch, making it particularly dangerous. This could become an even bigger problem if fentanyl starts entering the supply.
• Law enforcement officials worry that cheap ketamine manufactured overseas could fuel the U.S. market for pink cocaine.

Why is it in the news now? The drug is garnering attention due to recent high-profile cases, including Sean “Diddy” Combs’ allegations of sex trafficking and former One Direction star Liam Payne’s recent death.

Source: What Is ‘Pink Cocaine’? (The New York Times); It’s hot pink and smells sweet. But the party drug tusi can prove deadly. (The Washington Post)