Timothy O'clair and Mental Health Parity

Floor Speech

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Mr. TONKO. Mr. Speaker, I rise today to urge all of us to demand mental health parity enforcement in honor of a young man that I once represented, Timothy O'Clair.

I first met Timothy when I served in the State Assembly in New York. Timothy played Little League and had a smile and spirit that burned incredibly bright. He played in the chess club and was an avid bowler.

Timothy enjoyed gymnastics, playing the piano, fishing, golfing, boating, and drawing. He enjoyed the outdoors and was an avid animal lover. However, Timothy suffered from significant mental health challenges, and his family struggled along with him, fighting with insurance companies to get him the care he truly needed.

The insurance companies didn't know the Timothy that I knew. Where we all saw an extraordinary little guy in a fight for his own life, the insurance company saw expenses in a ledger book. They put caps on his care and denied coverage for needed mental health treatment. When Timothy received the care he needed, he thrived. However, his family always knew that those caps and denials of coverage were right around the corner.

Things got worse for Timothy. In order to get him the Medicaid coverage he needed, Timothy's parents were forced to legally disown him. Can you imagine being forced to make that decision in your own family? Unfortunately, for Timothy, even that was not enough.

At 12 years old, Timothy completed suicide.

Timothy's memory will never leave me. His spirit inspired me and a number of other committed advocates to write and advance Timothy's Law in New York State, one of the first mental health parity laws in our country.

Specifically, Timothy's Law required parity in insurance plans between mental health and general health benefits.

Passing Timothy's Law gave me the drive to improve the way that we approach mental health care in America nationwide.

To me, that means reducing the stigma for those seeking care, addressing the growing problem of the youth behavioral health crisis, and giving our healthcare professionals the resources they truly need to adequately recognize and address the challenges those who live with mental illness must grapple with each and every day.

It also means ensuring that parity is fully enforced.

At the Federal level, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 sought to correct the imbalance between the benefits afforded mental health and substance use disorders under group health plans and general medical and surgical benefits typically afforded under such plans.

Mr. Speaker, 15-plus years later, we still are seeing major gaps in access and affordability between mental health and physical healthcare and the need for better enforcement of this law.

For example, studies show that insured people are nearly four times as likely to go out of network and pay higher fees for mental health care than for physical healthcare. With one in five Americans impacted by mental health disorders, we must do better.

After many years of engaging on this issue and Congress passing more laws to strengthen parity, I was excited to see the Biden-Harris administration push to update the final parity rules which will allow for greater access to mental health and substance use disorder care.

These regulations implemented an update in the law to close gaps and improve compliance with parity, which is critical for the 84.5 million Americans with these conditions.

I had hoped that these rules would finally clarify and strengthen protections, while reducing barriers to treatment for mental health. These rules would have required health plans to make changes when they are providing inadequate access to mental health and substance use care.

These rules would have made clear that plans cannot use more restrictive prior authorization, or other medical management techniques, or narrower networks to make it harder for people to access mental health and substance use disorder benefits than their medical benefits.

These rules would also have closed loopholes and required more than 200 additional health plans to comply with the parity law, providing critical protections to 120,000 consumers.

However, in response to a recent lawsuit, the Trump administration released an announcement that it no longer plans to enforce the 2024 regulations to protect individuals with mental health conditions and substance use disorders from discrimination in health insurance.

Together with 17 of my colleagues, I have written to the Trump administration urging them to reverse course on this senseless decision. We shared our strong bipartisan sentiment that this decision ``marks a dangerous step in the wrong direction.''

We shared that it is clear that health plans are still consistently violating the law and systematically limiting access to mental health and substance use disorder care. Rather than pausing enforcement or reconsidering the regulations, now is the time to strengthen enforcement and meaningfully provide and protect our constituents from discrimination and improve access to care.

There are so many more like Timothy out there right now suffering and in very real danger of losing access to lifesaving treatment. Instead of denying them that care, let's support enforcement of our mental health and addiction parity laws.

For Timothy and his family and friends, the battle continues to achieve this.

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