California is facing a mental health crisis, particularly among its young people. A recent study found that 94% of those surveyed between the ages of 14 and 25 reported struggling with mental health challenges, and one-third rated their mental health as fair or poor. However, accessing mental health care is a significant challenge due to a lack of providers, defunding of Medicaid and Obamacare, and insurance companies denying care.
The Oakland-based advocacy group Children Now has consistently given California low grades for supporting kids’ mental health needs. To address this issue, state Senator Scott Wiener introduced the Health Insurance Accountability Act, which would require insurers to publicly disclose how often they deny care and face fines if their denials are overturned too often upon appeal.
The stakes are high, with inadequate access to mental health care services having a domino effect on families. Kaiser Permanente, the state’s largest health program, has been fined and cited repeatedly for its failure to provide sufficient mental health services. When someone is denied medical care, they can appeal, but the process is opaque and time-consuming, and most people don’t even attempt it.
A review of federal data found that fewer than 1% of denied claims are ever appealed, resulting in a massive financial win for insurers. The appeals process also disproportionately affects immigrant and English-second-language families, who are less likely to appeal their cases. However, when appeals do make it to the state level, patients are approved for the medical care they need 73% of the time, suggesting that insurers are engaging in widespread violations of state law.
Wiener’s bill aims to hold health plans accountable for unwarranted denials by requiring them to disclose denial rates and imposing fines for excessive denials. However, the bill’s prospects for passage are uncertain, with the health insurance lobby expected to push back. The California Association of Health Plans opposes the bill, citing concerns about duplicated reporting requirements and excessive penalties.
The issue of health care access is critical, particularly with expiring federal subsidies and skyrocketing premiums leading to a decline in Affordable Care Act enrollments. Officials say that reducing access to care is worrisome, especially for California’s kids and their mental health. Forcing insurers to make public their denial rates is a first step towards greater accountability, and Wiener’s bill is a crucial step in addressing the state’s mental health crisis.