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President Donald Trump frequently looked at mental health issues during his first term and framing it as a national crisis that called for action. He linked it to an opioid addiction, mass shootings and a surge in veteran suicides. And he later used it to oppose Covid-19 lockdowns and school closures.
Sometimes he backed up rhetoric with his actions. His administration has issued tens of millions of dollars in grants to expand community mental health services and has continued ongoing funding agreements to enforce comparable regulators requiring insurers to treat mental and physical health care equally.
But just months after Trump returned to president this year, his administration suspends new rules issued in President Joe Biden’s final months designed to enhance mental health protections and keep him accountable when insurers illegally refuse to compensate. That suspension comes after an industry group advocating for large employers on issues related to employee benefits.
Additionally, Congress cut funding for EBSA, a small agency in the Department of Labor that implements mental health through employee benefits security management or health insurance plans sponsored by most employers. This squeeze is primarily due to the expiration of temporary supplementary funding approved weeks after Biden was elected president, before he took office.
While the impact of these changes is difficult to measure, federal employees, policy experts and frontline workers have warned that suspensions of rules and cutting capital can have serious consequences. They say it could mean longer waits when patients challenge insurance decisions and fewer surveys of health plans for insurance companies and employers over possible federal mental health protection violations, and fewer people go to people who are legally unqualified.
Their long-term forecasts include more untreated mental illness and growing anger towards insurance companies.
“Imagine you’re a parent calling about the life-saving care your child needs,” said Ali Kawar, the second commander at the EBSA before descending at the end of the Biden administration. He said there were fewer money and fewer employees, and the agency was not equipped to open a new survey anytime soon.
The suspended rules were intended to strengthen enforcement of the 2008 Mental Health and Addiction Equity Act. The inability to provide access to the same level of mental health care as physical care has been well documented by researchers and recent Propublica research. Insurance companies often block care, can pay mental health providers, and find it difficult for patients to find help.
The rules released in September 2024 required a health plan to collect and report detailed data on how to limit or reject mental health claims. If the plan found a gap compared to healthcare, the insurance company had to explain what they were doing to fill those gaps. This is a requirement put on hold by the Trump administration.
In his first term, Trump took himself as an advocate for expanding mental health services and strengthening parity enforcement. His Opioid Abuse Committee, although Congress never approved the proposal, even recommended that the EBSA be given the power to punish insurers who violate the parity rules.
However, after taking office, his administration moved to roll back several Biden-era initiatives, from solar energy grants to student loan relief. The new parity rules were no exception.
A few days before Trump’s second inauguration, Eric, a trade group representing ERISA Industrial Commission or large employers on employee benefits policies, was sued to block regulations. The Trump administration then went to court and asked for the lawsuit to be suspended while considering whether to cancel or amend the rules.
The federal judge granted the request, and the Trump administration has pledged to not enforce them during the lawsuit or for 18 months thereafter.
Eric says the new rules exceed what Congress intended when they created the Mental Health Act, and are ambiguous and burdensome. But supporters of the new rules said the lawsuit effectively hampered the strongest protections of the Parity Act.
“What we’re hoping for was that these rules are extremely important in promoting better compliance,” Kawar said. “So now, it’s on hold, so that’s an important advantage that will never be realized.”
James Gelfund, Eric’s president and CEO, said he believes the Biden administration has gone too far.
“We generally support mental health, but we don’t support this rule,” he said. “I don’t think the Biden administration had the authority to write it,” he added, creating “an impossible standard that we cannot meet,” and that the rules are “deliberately vague, so they can choose to force them on the person they like whenever they want.”
The EBSA protects workplace benefits for 150 million Americans, but has always had to compete against a small number of staff and struggled under the Biden administration, which supported its mission. In a 2023 report to Congress, the agency admitted that using one investigator for every 7,700 health plans, its resources are “restricted compared to the vast universe it regulates.”
These restrictions were shown in the results: Between February 2021 and July 2024, the EBSA conducted 150 investigations and issued 70 letters finding violations of the Equality Act.
And now it’s moving forward with much fewer employees. The Senate Approval Committee proposed to retain basic EBSA funding at the same level as last year, but there are no temporary boost meetings provided under the December 2020 Surprise Act. Designed to protect patients from surprise health bills, the law included additional funds to help the EBSA handle complaints and new surges in liability.
The funds expired a few months after Biden resigned. With that support gone, EBSA’s workforce is expected to drop by nearly a fifth from two years ago, from 831 workers in 2024 to less than 687 employees in 2026.
The Senate Budget Committee shows that enforcement of mental health remains a priority. This includes supporting additional efforts aimed at auditing systematic and covered health care coverage provided by employee-sponsored plans and including a note from the bill report, “ensuring the scope of mental and physical health insurance required by current law.”
Gelfand said his group wanted the EBSA to be “robustly funded” so he could work to help employers follow the law. However, he said his organization supports not adding funds until EBSA’s mission changes.
Many positions were lost due to funding for the No Surprise Act and the months leading up to the start of Trump’s second term, but other staff left shortly after Trump took office through a voluntary separation package.
Neither the White House nor EBSA representatives responded to questions about suspended rules or funding cuts.
Frontline workers said that on so many departures, important institutional knowledge has been lost. Losses have been hit hardest in two key areas. Competing benefits advisors from people across the country facing insurance denials they think are wrong have fallen by about 30%. Current and former employees say that research staff who guide detailed investigations to insurance practices have been reduced by nearly 40%. As a result, investigators are juggling higher caseloads, and those seeking help face longer delays.
EBSA oversees a wide range of employee benefits, including retirement plans, health insurance and protections under federal labor laws. In recent years, current and former staff say enforcement of mental health laws accounts for about 25% of the investigation work.
Agents have the authority to support millions of patients who have health insurance through their workplaces. When investigators reveal systemic violations, they can request what is called global corrections and force insurance companies and plan managers to resolve numerous planning and patient issues. For example, after an investigation by the EBSA’s Kansas City Office, the primary claims manager agreed to stop refusing to drug testing related to drug use treatment, reprocessing more than 3,000 claims and returning nearly $2 million to patients and health care providers.
For some families, it could be a matter of life and death.
He passed away without obtaining the mental health care he sought. The new lawsuit says his insurance company’s ghost network is liable.
During the darkest months of the pandemic, a Massachusetts woman asked her name to be withheld to protect her teenage daughter’s privacy, but she saw her child unravel. The girl, isolated at home, began following social media videos about people cutting herself, and quickly began doing the same thing. She became very anorexic and began talking about suicide.
The parents admitted their daughter to a residential treatment center, believing that it was her best chance of improving. However, their insurers refused coverage, leaving behind an invoice of over $80,000. Then it was a two-year battle for a refund. So she sought help from the Ministry of Labor. EBSA investigators took the case and helped her navigate the complicated claims process and defend her in negotiations with the insurance company.
Last year, the insurance company agreed that the claim was “erroneously rejected” and agreed to repay most of what the family paid.
