Editor’s note: In a court filing, the Trump administration said it intends to reconsider—and not enforce— parts of this final rule. The administration asked that the case be placed in abeyance as reconsideration of the regulation proceeds. The Trump administration could modify last year’s final rule, rescind it or propose a new one.
The AMA is urging the Trump administration to vigorously defend the Mental Health Parity and Addiction Equity Act that President Donald Trump signed into law in 2020.
The law, originally passed in 2008, mandated that insurers that cover mental health and substance-use disorders treat those services similarly to how they treat medical and surgical care. After widespread disregard of the law, federal regulations were put in place to implement its provisions—including a final rule in September 2024 (PDF) that would make enforcement easier.
In January, the ERISA Industry Committee—a national association advocating for the employee-benefit interests of large U.S. employers—sued to stop the September 2024 final rule from taking effect and the Trump administration has until May 12 to decide how to respond.
The AMA’s March letter (PDF) to the secretaries of Labor, Treasury, and Health and Human Services highlights how defense of the law and its clarifying rules would further the Trump administration’s commitment to fighting the epidemic of substance-use disorder in the U.S. Earlier this year, President Trump declared a national emergency related to the flow of illicit synthetic opioids like fentanyl into the country.
“No part of our society—not young or old, rich or poor, urban or rural—has been spared this plague of drug addiction,” the president said in declaring the opioid crisis a public health emergency in 2017. “We owe it to our children and our country to do everything in our power to address this national shame and this human tragedy.”
In 2018, President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act—the SUPPORT Act, for short. The law sought to increase access to treatment and recovery services for substance-use disorder and reduce the supply of illegal drugs. The SUPPORT Act specifically mandated parity in coverage of mental health and substance-use disorder services in Children's Health Insurance Program plans. The AMA supports a bill pending in the House of Representatives that would reauthorize the SUPPORT Act.
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Adding teeth to 2008 law
The final rule implemented in 2024 furthers the aims of the 2008 Mental Health Parity and Addiction Equity Act, shoring up guarantees that health plans treat mental health and substance-use disorder benefits similarly to medical and surgical benefits. The rules clarified and reinforced restrictions on nonquantitative treatment limitations and require data collection, analysis and action to address disparities in treatment coverage. These rules also ended the opt-out provision for certain governmental plans.
At the time, the AMA noted that the rule was desperately needed to combat insurers' persistent noncompliance.
For example, a 2022 U.S. government report found that insurers often provide unequal coverage for mental health and substance-use disorder treatment, giving the example of a health plan that covered nutrition counseling for medical conditions such as diabetes but not for mental health conditions such as anorexia nervosa.
Successive reports from the Labor, Treasury and Health and Human Services departments in recent years all found widespread failures, as documented in a 2024 AMA issue brief (PDF).
Lifesaving policy
Research shows that health plans covering treatment for mental health and substance-use disorders saves lives. The “misguided lawsuit and disingenuous allegations threaten to undo considerable positive progress made by the Trump administration—and the nation cannot afford to slide backwards,” wrote James L. Madara, MD, the AMA’s executive vice president and CEO.
Federal law already requires similar treatment for mental health and substance-use disorder treatment, Dr. Madara’s letter notes. The September 2024 rule that employers are trying to stop merely clarifies the existing 2008 law.
The business group’s “lawsuit is an attempt to hamstring the Trump administration’s ability to stop practices that increase administrative waste and harm patients,” Dr. Madara wrote.
