The sad truth about medicine today is that patients with an urgent injury or illness can often receive care immediately, but those experiencing a mental health crisis or a substance use disorder can struggle indefinitely to secure the help they need.
That’s why I was excited about the release of the nationwide Mental Health Parity Index, which marks a defining moment for millions of Americans with commercial insurance who are trying to access behavioral health care. For the first time, we have real-time, insurer-reported data broken down by county that clearly shows where access is problematical, and how payment practices and network composition are making a difficult situation worse.
The findings are unmistakable. This collaborative effort—led by The Kennedy Forum, Third Horizon, American Psychological Foundation, Ballmer Group, and the American Medical Association—details exactly how and where the nation’s four largest payers have work to do to live up to the promise of state and federal mental health and substance-use disorder (SUD) parity laws.
The results illuminate persistent gaps in access and payment disparities between behavioral and physical health care that stand in the way of timely, whole-person care for patients with mental health and substance use disorders. Breaking data down to the county level aligns the statistics with the real-life experiences of individuals and families, who must often travel significant distances or pay steep out-of-network costs because local clinicians aren't covered by their health plan.
The truth is, behavioral health needs in the U.S. continue to rise, not fall. But the health care system intended to meet those needs remains fragmented and, too often, inequitable. The Mental Health Parity Index alone doesn’t solve those problems, but it gives us something we’ve been missing: a clear, transparent line of sight. And in health care, you can’t fix what you can’t see.
A groundbreaking tool
Launched April 14, the national Mental Health Parity Index quantifies disparities across the nation’s four largest commercial insurance plans. Among its key findings:
- Disparity in access: In 43 states, enrollees face clear disparities locating in-network clinicians for mental health care or substance use disorder treatment compared to physical health clinicians. The gap is so stark that seven in 10 counties nationwide report similar access challenges.
- Disparity in payment: All states show lower payment levels for outpatient mental health care and substance use disorder treatment than for physical health care. Physicians and other health professionals providing behavioral health services are paid 16% to 59% less, on average, than those treating physical health conditions, discouraging network participation and compounding shortages.
- Out-of-network issues: Due to disparities in both access and payment, patients often are forced to seek care out-of-network with higher costs. There is a 24% to 83% difference in in-network access for physicians and other providing physical health care relative to those available in-network for mental health care and substance use disorder treatment.
These results, compiled from insurers’ own public contract data as required by federal Transparency in Coverage rules, allow us to complement individual anecdotes and widespread frustration with transparent, actionable facts. Transparency brings responsibility. The Mental Health Parity Index highlights potential disparities with greater clarity, enabling more precise and productive discussions about where and why patients struggle to obtain care.
By focusing on both gaps and successes, the Mental Health Parity Index can help drive meaningful reform: promoting accountability, spotlighting effective insurer practices, and fostering collaboration to ensure mental health and substance use disorder parity translates into real, timely and high‑quality care for patients.
Uneven monitoring, poor enforcement
The promise of parity remains unrealized, despite the legal framework established by the Mental Health Parity and Addiction Equity Act of 2008 and reinforced by subsequent legislation. Inconsistent monitoring and lax enforcement have allowed health insurance plans to circumvent the key directives of the law.
We see it in the day-to-day experience of patients and physicians: excessive prior authorizations, restrictive formularies, and provider networks that are simply too narrow to meet demand. These aren’t administrative inconveniences—they are barriers to care.
And those barriers have consequences. They reinforce stigma. They delay treatment. And in too many cases, they lead to outcomes that could have been prevented with timely, evidence-based care. Structural obstacles like these remain one of the biggest reasons patients don’t get the help they need when they need it most.
That’s why organizations like The Kennedy Forum are encouraging physicians, health professionals patients and families to speak up. Behind every data point is a real-life experience, and those stories are essential to driving sustainable change.
Realizing parity in practice
The Mental Health Parity Index shows us that some health plans appear to have robust network composition, and some payers in some counties have payment parity as well. It can be done. It is now up to insurers, employers, policymakers, and clinicians to leverage this transparency to strengthen networks, improve payments, and eliminate access disparities. This is where another advantage of the Mental Health Parity Index’s data precision comes into play: Counties with severe parity discrepancies can find a road map for correction at another county, perhaps within the same state.
The AMA will continue leading the charge, fighting for the care our patients deserve and are entitled to under the law. We urge all stakeholders to engage with the Mental Health Parity Index, share their experiences, demand accountability, and work together in pursuit of a system that truly delivers on the promise of parity.
We are helping build a future where high-quality behavioral health care is respected, funded and accessible for every patient, everywhere.
