By Bill Smith, CEO of Inseparable

Have you ever tried to book an appointment with a therapist listed in your insurer’s directory—only to learn they aren’t accepting new patients? Or had care denied that a doctor said was medically necessary? If insurance premiums feel out of reach, you’re not alone. Across the heartland, families face these frustrations every day. What feels personal is, in fact, systemic.

Health care in America—especially mental health and substance use care—has become harder to access and harder to afford. Premiums rise as benefits shrink. Medicaid cuts leave vulnerable people without coverage. Families searching for care are often met with provider shortages, surprise bills, and insurance denials. Even when they find an appointment, high out-of-pocket costs can push them toward financial crisis.

The consequences are real and lasting. When care is delayed or denied, addictions go untreated and manageable mental health conditions worsen—driving higher costs for families and communities alike.

At Inseparable, our credo is simple: good mental health care should be easy to get and easy to afford. For too long, the system has treated mental health as optional. The good news is that lawmakers are beginning to show a better path forward.

When we say mental health care should be easy to get, we mean meeting people where they are—especially kids. Today, more than half of young people with major depression receive no treatment at all. In a September 2025 representative survey of 2,700 mothers conducted with Count on Mothers, moms described worrying about their children’s mental health while struggling to overcome barriers like cost, limited availability, and lack of time. Again and again, they told us the same thing: making mental health services more available would be the biggest difference-maker in helping their kids get care. Lawmakers across the Heartland—from Kentucky to Alabama to Ohio and Michigan—are meeting the moment by investing in school-based mental health services, strengthening support in the places where students already spend their days.

In my home state of Alabama, Gov. Ivey signed a bill in 2022 to place mental health coordinators in every school district, helping schools identify students who need support and connect them to care earlier. That same approach is gaining momentum across the Heartland, with states like Kentucky, Michigan, Georgia, Pennsylvania, and Colorado making major investments in school-based mental health care, crisis response, and free services for youth. 

“Easy to afford” means that people can afford health coverage in the first place—and that their insurance actually covers the care their family needs.

When cuts to Medicaid threatened to put health care out of reach for millions of Americans, states were pushed to the frontlines of implementing major changes while protecting access to care. Inseparable partnered with Heartland Forward and Mental Health America to convene leaders from 28 states—including delegations from  the Heartland Health Caucus, Alaska, Utah, Colorado, Connecticut, Michigan, and North Carolina—to collaborate on implementation strategies to keep people connected to care. Thoughtful, bipartisan leadership over the coming months and years will be essential to ensuring families aren’t priced out of coverage entirely.

While Medicaid is the largest payer for mental health care (25 percent) and substance use treatment (40 percent) in America, commercial insurance is also a critical part of achieving better mental health outcomes.

Over the past several years, Inseparable has worked alongside families in Michigan fighting for better access to care. Through that work, we met Allyson, whose son Ben was diagnosed with autism at age two. What followed, she told us, was “a tremendous rollercoaster of insurance battles” as her family tried to get him the care he needed.

As Ben grew older, his behaviors escalated and became dangerous. After years of failed attempts to secure appropriate therapies, doctors determined he needed inpatient psychiatric care. Yet just ten days into what was expected to be a months-long stay, the insurance company cut off coverage—leaving Allyson with a bill of more than $140,000.

As unimaginable as it sounds, Allyson’s story is not unique. That’s why what’s happening in Illinois matters so much.

In May 2024, Governor J.B. Pritzker signed the Health Care Protection Act into law—one of the strongest state efforts in the country to modernize insurance practices and expand access to mental health and substance use care. The law keeps clinical decision-making between patients and their doctors.

It ends prior authorization and step therapy for critical mental health care, requires insurers to use the same evidence-based standards clinicians apply when determining medical necessity, strengthens oversight of provider directories, and prohibits misleading insurance products that fall short when people need care most.

Illinois has continued to build on this progress. In December 2025, lawmakers established reimbursement rate floors for in-network behavioral health services. While technical, the impact is significant. When reimbursement rates are too low, providers leave insurance networks—reducing patient choice, increasing wait times, and increasing out-of-pocket costs. Addressing payment adequacy helps stabilize provider networks and improve access statewide.

But Illinois is not alone. Across the Heartland, governors and legislators in red and blue states alike—from Arkansas to Oklahoma to Washington—are advancing reforms to ensure policyholders can get the care their insurance promises.

Together, these changes are making it easier for millions of people to access mental health care when they need it. That’s what meaningful progress looks like for Heartland families.

There is still work ahead. We must push for real solutions and not let politics interfere because too many families remain stuck in broken systems. But the momentum building in the heartland offers something powerful: proof. Proof that leaders can act with urgency and compassion. Proof that good mental health care can be both accessible and affordable. And proof that when families share their stories, real change is possible.