Op-ed: Federal Policy Change Could Harm Mental Health Response During Pandemic

One in five Americans lives with a mental health condition.  With COVID-19 continuing to spread rapidly through many communities, what is now a significant health challenge is on track to become a severe mental health crisis for Washingtonians.

A recent analysis[1] by the Washington State Department of Health (DOH) reports a surge in behavioral health symptoms and anticipates that 30 to 60 percent of our state’s population will likely experience symptoms of depression in the coming months. A response to the threat of the virus itself as well as the financial, emotional, and physical strain it has caused, the DOH estimates that 2.25 to 4.5 million Washingtonians will undergo feelings of depression, with even more suffering from anxiety and acute stress.

At the National Alliance on Mental Illness of Washington (NAMIWA), we focus on improving the quality of life for those affected by mental health conditions.  In this time of unprecedented hardship, people suffering from mental health conditions face unique challenges.



Left untreated, symptoms can compound and result in deteriorating mental health, higher rates of substance abuse, and ultimately, greater incidents of suicide. To help people through this crisis, we must remove barriers to mental health treatment and promote coverage.  Access to prescription drug therapies is an important component of mental health coverage.

Unfortunately, the federal government is marching in the wrong direction on this.  Recent policy decisions by the Trump Administration will make it harder for the anticipated influx of mental health patients to afford their medicines.

In the midst of a global pandemic, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), announced[2] a rule that allows insurance companies to charge patients more in out-of-pocket costs by ignoring the contribution prescription assistance programs provide in calculating whether patients reach their co-pay thresholds or cap.  Let that sink in: at a time of national crisis, the Administration is greenlighting a plan that will take money out of patients pockets and put it into insurance company bank accounts.  All while record numbers of Americans are losing their health insurance[3].

Prescription assistance programs keep medicines affordable for everyday Americans by reducing the out-of-pocket costs patients are required to pay. By allowing insurers to not count external patient assistance towards a patient’s out-of-pocket maximum or deductible, HHS is incentivizing insurers to increase prices and reduce healthcare coverage.

With this change in policy, patients will now have to pay more out-of-pocket before they hit statutory “caps” on their personal contribution towards the cost of their medicine. This change will cause more patients to skip scheduled treatments or abandon their medication in its entirety due to cost.

Mental illnesses are, all too often, heavily influenced by external forces. For that reason, insurance companies must think critically before implementing adjustment programs that increase patient cost liability. Changing how insurance plans operate can result in thousands of dollars in increased bills.

Given the already-increased levels of stress caused by COVID-19, by decreasing affordability and accessibility of prescription medication, the imposition of this policy will exacerbate Washington State’s incoming mental health crisis.

But that doesn’t mean we are powerless to fight the coming storm. In Washington State, and across the nation, we can come together to support those struggling with mental health issues. Everyone must do their part to provide patients with the resources, medication, and help they need to cope with mental illness. For insurers, that means rejecting a policy that allows them to profit more at the expense of our most vulnerable.

Lauren B. Simonds, MSW, is the Executive Director & CEO of the Washington Chapter of the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. The NAMI Washington Alliance consists of 19 affiliates in local communities across the state providing support and community education services to individuals living with mental illness and their families.