LISTEN: Mental health advocates say if all Georgia insurance companies followed parity law, more people would be seeking treatment for mental health and substance use disorder. GPB’s Ellen Eldridge reports on advocacy efforts during this week’s third annual Mental Health Parity Day at the state Capitol.
Georgia's Mental Health Parity Act, passed unanimously by the Legislature in 2022, requires public and private insurers to cover mental health and substance use disorder in the same way as with physical health care.
But it's not just a mental health issue, advocates with Georgia Council for Recovery said Tuesday at the Central Presbyterian Church near the Gold Dome for the third Mental Health Parity Day hosted by The Carter Center.
Advocates say enforcing parity law is about reducing emergency response costs, saving taxpayer dollars, and building healthier communities across Georgia. Mental illness is often expressed as behavioral health concerns such as substance use disorder. Outside the city's Capitol steps, people live in tents and in need of food.
“These are our sons, our brothers, our sisters out here on the streets,” Office of Insurance and Safety Fire Commissioner John King said, gesturing toward the church windows with a line of people outside seeking charity. “A lot of these young men waiting outside this facility are veterans and they've been over-prescribed opiates.”
The No. 1 cause of death in the United States for people between 18 and 45 years old is fentanyl poisoning, and veterans face an overdose death rate of up to twice that of civilians.
As much as King said the unhoused deserve treatment, his office is not involved with the day-to-day business of health care policies. Rather, he compared his job to the work of a traffic cop who keeps companies accountable by pulling them over and writing a ticket.
Violations of state parity law in Georgia happen when private insurers don't pay the same. For example, covering the same portion of an emergency room bill for a broken bone as an inpatient mental health break.
The first mental health parity data-call report required by the new law was issued Aug. 15, 2023, and King's office said it conducted comprehensive audits of private health insurers that took years. The investigations took longer depending on the company’s size, the complexity of the examination and the need for accurate results that stand up under legal scrutiny, King said.
In all, 22 private health insurance companies were fined a total of about $25 million. They were also provided a work plan on how to comply with the law.
"And we're going to continue monitoring very carefully," King said. "But if we don't get compliance, we will be back at this juncture again, and the penalties will not go down. They will continue increasing until we get compliance."
Compliance for people with private health insurance would mean the ability to find an available therapist, certified peer specialist or other mental health provider. People less often report a lack of access to a heart specialist, but behavioral health experts are increasing leaving insurance networks.
King said his job is not “to beat up companies because they don't have network adequacy,” but to work with private insurance companies and partners in the state government to fix the problems.
"They're turning around and saying, 'I'm trying to hire more clinicians, but they're not available in this part of Georgia,'" King said.
The Office of Insurance and Safety Fire is not involved with provider-network contract negotiations but oversees regulations. King said he is responsible for regulating the insurance industry while maintaining an environment that’s good for business.
"It's that careful balance," King said. "I'm the advocate for the consumer, but I can't wreck the industry in the process."
The commissioner spoke Tuesday about the nearly $25 million in fines his office levied against those 22 insurers for violations made in 2022.
"I think the companies ought to pay attention," King said. "I told them they needed to pay attention to this and that. Apparently, they didn't take me seriously. Well now this is my effort for them to understand that I'm serious about this."
Despite King's seriousness, the sanctions are not significant enough to effect change, Breedlove said.
"The fines levied by officials in the state of Georgia must be larger than a rounding error to Big Insurance," he said.
Breedlove said every single dollar should go to a program to aid a family or an individual affected by mental health or substance use disorder due to the inaction of insurance companies.
"Both sides of the equation must have access to those fines," Breedlove said. "That is blood money, that is our money, and we demand and want our money."
The funds currently collected go into the general fund of the state treasury and is accounted for in the state budget.
"The Legislature and the governor's office will make those decisions," King said.
The Carter Center's Tuesday program announced Georgians for a Healthy Future's new public tool to track parity violations.
The dashboard will provide transparent, real-time monitoring of compliance using a straightforward stoplight indicator system to show where implementation is on track, where progress is mixed, and where critical gaps remain.
Consumers who believe they are victims of a mental health parity violation may file a complaint online or call 1-800-656-2298.
