David Lloyd was drawn to the policy world early on. He worked for home-state Senator Debbie Stabenow of Michigan after college, earned an MBA at Northwestern University, and went back to Stabenow’s office as an advisor on international trade. But it wasn’t until he took a job as policy analyst for a children’s organization in Chicago that he found his calling: advocating for people, often poor, who were underserved and had little political power.
In five years with Voices for Illinois Children, he went from being an analyst to directing the organization’s fiscal policy center, always thinking about how to boost funding and build effective programs for kids — especially in the area of mental health. “Children’s mental health became a passion,” Lloyd says. “We focused a lot of our attention on childhood trauma and working to boost home visiting programs.”
By then Lloyd was determined to make mental health services more broadly available. He went to work for another organization fighting for change in the mental health arena, The Kennedy Forum. It was founded by Patrick Kennedy, who represented Rhode Island for 16 years in Congress and went public in 2008 about his own battles with bipolar disorder and addiction.
That same year, Kennedy’s most important piece of legislation, the Mental Health Parity and Addiction Equity Act, was passed by Congress and signed into law. It requires that insurance companies pay for treatment of mental illness and addiction on the same basis as they cover physical health conditions.
Twelve years after the law’s passage, parity is far from being realized and the Forum’s most urgent priority is to make good on the promise of the landmark law. But because private health insurers are often regulated at the state level, making progress towards real parity requires a state-by-state approach, Lloyd says.
Lloyd joined the Forum’s Illinois team in 2017 and helped lead the successful push for a state parity law there, which he says is “one of the strongest in the country.” Fresh from that success, he transferred to the Forum’s national office as a senior policy advisor. For the past year, one of his biggest areas of focus is the push for strong parity legislation in California. On this and other battles, Lloyd works closely with the Steinberg Institute.
Parity with medical services in insurance coverage is crucial, Lloyd says. “You can’t just rely on grant programs; you can’t just rely on discretionary budget lines in state or federal budgets,” he says. “Mental health needs to be paid for the same way other types of health care are paid for, and that’s through the insurance system.”
To Lloyd, the way the U.S. health care system approaches mental health services is wrong-headed and counter-productive — and, as a result, far more expensive than it should be.
“It’s so obvious that we often wait until the very end to try and help people who have serious, untreated mental health and substance use disorders,” he says. “If we just acted sooner and worked to prevent problems, there would be much better outcomes both for individuals themselves and for our economy, our productivity. The outcomes are much worse when you wait until the end.”
The Forum also works with partners and allies to help state regulators enforce parity laws. In California, that means dealing with two regulators, one that tracks managed health care plans and another that regulates a strange mix of commercial health insurers and those that sell insurance products covering autos, boat, and lives.
Health insurance is often extraordinarily confusing for patients and their families, and when they are denied coverage — often during a crisis — it is difficult for families to navigate the current system.
“We have to build power in order to affect change,” Lloyd says. “That means people need to know their rights and they need to know how to assert them.” One of the Forum’s strategies is to collect stories of patients who are denied coverage for behavioral health services by their insurance companies. These stories, often desperately sad and painful, are powerful tools in the effort to create true mental health parity — and remind Lloyd never to give up.
This is especially important in the era of Covid-19. On the federal level, Lloyd and the Forum are pressing hard for Congress and the Trump administration to address the massive impacts of the Covid-19 pandemic on the mental health of Americans and to make desperately needed funding available to support mental health services and practitioners.
He points to a recent survey by the National Council for Behavioral Health, which found that time is running out. Nearly two-thirds of community behavioral health providers say they’ve lost so much revenue from the national shutdown that they can’t hang on financially for more than three months if present trends continue. Nearly half have laid off staff and a third have turned away patients.
“A lot of providers will be closing programs or closing their doors if they don’t get emergency aid,” Lloyd says. “If you let the system collapse you don’t have much of a hope of increasing resources to meet people’s needs. We need to dramatically ramp up the federal response.”
The good news is that Congress approved $175 billion to support health care providers. The bad news is $100 billion of that has already been allocated and mental health providers got very little. Lloyd says the need is enormous, and that mental health providers should get a significant share of the remaining $75 billion.
“We’re not talking about a few hundred million,” Lloyd says. “We need tens of billions at the very least, just to stabilize the system.”
That’s the case Lloyd will be making to Congress, using the skills and connections he’s made over many years.
“He’s very motivated and works around the clock,” says Garry Carneal, an attorney who works with Lloyd at the Forum. “But he’s also blessed with a temperament that facilitates forward motion.”