This week, we learned that nearly every large employer in America offers mental health benefits. We also learned that fewer than half of them know if those benefits actually work. Released on World Mental Health Day, new research from the Employee Benefit Research Institute revealed what many employees already suspected: coverage exists, but care doesn't. Meanwhile, California is moving in the opposite direction—strengthening mental health parity rules while the federal government fights over whether to extend basic ACA subsidies. Here's what happens when the gap between "offering benefits" and "delivering care" becomes impossible to ignore.
The Accountability Crisis: When Mental Health Coverage Doesn't Mean Care
We've normalized offering mental health benefits. We haven't normalized measuring whether they work.
This week's EBRI survey drops a number that should make every HR leader and benefit broker uncomfortable: 97% of large employers offer mental health coverage, but fewer than half track whether employees can actually access care. They don't measure wait times. They don't audit network adequacy. They don't know if their EAP's three free therapy sessions help anyone. They just know they checked the box.
And here's the result: employees with mental health conditions are twice as likely to report unmet care needs, even with employer-sponsored insurance.
The survey, released on World Mental Health Day, found that 97% of large employers provide mental health coverage and 67% include substance use disorder treatment — but measurement of outcomes and access lags far behind.
At the same time, Medicare reinstated in-person visit requirements for behavioral telehealth as of October 1, creating new barriers for rural patients and postpartum mothers who relied on virtual care.
California is moving the opposite direction: the state enacted landmark mental health parity regulations requiring insurers to prove they treat mental health equally to physical health — not just claim it.
The takeaway: The employers who win the next decade won't be the ones with the most benefits. They'll be the ones who can prove their benefits deliver care. That means tracking wait times, provider availability, and member satisfaction — not just plan features.
California Proves Higher Wage Replacement = Higher Utilization
When California increased paid family leave to 90% wage replacement for low-income workers in January 2025, skeptics worried about costs. Six months later, the data tells a different story.
Claims are up 16% overall — and up 25% among low-income workers. Translation: people weren't skipping leave because they didn't want it. They were skipping it because they couldn't afford it.
California's paid family leave expansion reached full implementation in January 2025, increasing wage replacement to up to 90% for low-income workers and 70% for middle-income workers.
The 25% spike among low-income workers proves the policy hypothesis: when leave is financially accessible, families use it. When it's not, they can't — no matter how family-friendly the culture claims to be.
For employers designing parental leave policies, this is your blueprint: higher wage replacement drives higher utilization. If your company's leave sits unused, the problem might not be culture. It might be economics.
The takeaway: Access isn't just about having a benefit on paper. It's about whether people can afford to use it before they burn out, give up, or go broke trying.
The Shutdown Isn't About Spending — It's About Healthcare
Day 14 of the federal government shutdown, and the fight isn't really about the budget. It's about whether enhanced ACA premium tax credits get extended past December 31.
Democrats won't budge without them. Republicans won't negotiate until they do. And Marketplace open enrollment starts November 1 — meaning families shopping for plans have no idea what subsidies they'll qualify for.
If the credits lapse, KFF estimates premiums for subsidized enrollees will more than double — from $888 to $1,904 annually — and 4 million people will lose coverage.
The shutdown is happening during the exact window when families need clarity about 2025 coverage. Instead, they're getting political theater.
For benefit brokers, this means client confusion during ACA enrollment season. Have talking points ready about subsidy uncertainty — and backup plans if credits don't extend.
The takeaway: Healthcare policy isn't abstract. It's whether a new parent can afford coverage during open enrollment. And right now, no one knows the answer.
Doula Care Moves from Luxury to Standard of Care
As of January 1, 2025, California's AB 904 mandates that health insurers cover doula services — including up to eight prenatal and postpartum visits, labor support, and care for miscarriage, abortion, and stillbirth. Medi-Cal also increased doula reimbursement rates in September 2025.
This isn't a niche benefit. It's a structural shift: doula care is moving from out-of-pocket expense to covered standard of care.
For OB/GYNs and midwives, this is your moment to educate patients that doula services are now covered through most California insurance plans — but many families don't know it yet.
For doulas, this is your opening to get Medi-Cal credentialed and reach underserved populations who were previously priced out of doula support.
For birth equity advocates, this is a model for reducing racial disparities in maternal outcomes. States that follow California's lead could make doula care a national standard.
The takeaway: When evidence-based support moves from luxury to coverage, access changes overnight. The question now is whether providers and families know how to use it.
Women's Health Venture Capital Finally Wakes Up
This week saw Midi Health raise $50M$ at a $150M revenue run rate, WellTheory close $14M with all-female institutional investors, and Jack Fertility secure £500K for at-home male fertility testing.
The signal? Women's health venture capital is finally thawing after years of underfunding. But it's still early — and the bar is high.
Midi Health now serves 20,000 women weekly, double from January. That's not a niche market. That's proof employers will pay for women's health benefits that reduce turnover and absenteeism.
WellTheory's all-female investor round highlights both progress and persistent gaps: nearly 80% of autoimmune patients are women, yet only 2% of U.S. venture capital goes to female founders.
For founders raising in this space, emphasize measurable clinical outcomes and employer partnerships — not just engagement metrics. Investors want proof of ROI, not vibes.
The takeaway: Menopause, maternal mental health, and autoimmune care are no longer "nice-to-haves." They're enterprise-sale-ready. The market has matured. The question is whether capital will keep up.
What This Week Means for You
If you're a benefit broker: Walk into your next client meeting with this question: "Do you know how many of your employees with mental health needs can actually access care through your plan?" Most won't know. That's your opening to pitch outcomes-based solutions that track wait times, provider availability, and member satisfaction.
If you're a provider: California's AB 904 means your patients now have insurance coverage for doula care—but many don't know it yet. Start asking about coverage during prenatal visits and educate families that doula services are covered for pregnancy, miscarriage, abortion, and stillbirth.
If you're a founder: This week's venture activity (Midi, WellTheory, Jack Fertility) proves investors are paying attention. Emphasize two things in your pitch: measurable clinical outcomes and employer/payer partnerships. The winners won't just serve patients—they'll show ROI.
If you're an HR leader: California's paid leave data offers a blueprint. When wage replacement increased to 90%, utilization jumped 25% among low-income workers. If your parental leave sits unused, the problem might not be culture—it might be economics.
What does this mean for the next generation of care? Forward this to someone who's shaping it.