Skip to main content
SpringerLink
Log in
Book cover

The Palgrave Handbook of American Mental Health Policy pp 367–387Cite as

Palgrave Macmillan

Mental Health Insurance Parity: How Full Is the Glass?

  • Chapter
  • First Online:

Abstract

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, the federal law requiring parity in coverage for mental health and substance use disorder (MH/SUD) services and medical/surgical services offered in group health insurance plans, was the culmination of over fifty years of advocacy and debate. Advocates had pushed for parity in response to long-standing differences in the generosity of private insurance benefits for MH/SUD vs. medical/surgical services that left many with mental disorders without sufficient financial protection from the costs of treatment. The Affordable Care Act (ACA), which expanded coverage of MH/SUD and other services for millions of Americans, extended parity requirements to many other populations. This chapter discusses the history of parity and related policies, their primary goals, and research that examines the effects of MHPAEA and ACA parity policies. It will then discuss market failures that remain for MH/SUD services.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Frank, R. G., & Glied, S. A. (2006). Better but not well: Mental health policy in the United States since 1950. Baltimore, MD: The Johns Hopkins University Press.

    Google Scholar 

  2. Barry, C. L., Gabel, J. R., Frank, R. G., Hawkins, S., Whitmore, H. H., & Pickreign, J. D. (2003). Design of mental health benefits: Still unequal after all these years. Health Affairs, 22(5), 127–137.

    Article  Google Scholar 

  3. Gabel, J. R., Whitmore, H., Pickreign, J. D., Levit, K. R., Coffey, R. M., & Vandivort-Warren, R. (2007). Substance abuse benefits: Still limited after all these years. Health Affairs, 26(4), w474–w482. https://doi.org/10.1377/hlthaff.26.4.w474.

    Article  Google Scholar 

  4. Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. The American Journal of Psychiatry, 167(11), 1321–1330. https://doi.org/10.1176/appi.ajp.2010.09121743.

    Article  Google Scholar 

  5. Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328–1333.

    Article  Google Scholar 

  6. Barry, C. L., Goldman, H. H., & Huskamp, H. A. (2016). Federal parity in the evolving mental health and addiction care landscape. Health Affairs, 35(6), 1009–1016. https://doi.org/10.1377/hlthaff.2015.1653.

    Article  Google Scholar 

  7. Hustead, E. C., & Sharfstein, S. S. (1978). Utilization and cost of mental illness coverage in the Federal Employees Health Benefits Program, 1973. The American Journal of Psychiatry, 135(3), 315–319. https://doi.org/10.1176/ajp.135.3.315.

    Article  Google Scholar 

  8. Reed, L. S. (1975). Coverage and utilization of care for mental health conditions under health insurance: Various studies, 1973–1974. Washington, DC: American Psychiatric Association.

    Google Scholar 

  9. Reed, L. S., Myers, E. S., & Scheidemandel, P. L. (1972). Health insurance and psychiatric care: Utilization and cost. Washington, DC: American Psychiatric Association.

    Google Scholar 

  10. McGuire, T. G. (1981). Financing psychotherapy: Cost, effects, and public policy. Cambridge, MA: Ballinger Publishing Co.

    Google Scholar 

  11. Hankin, J. R., Steinwachs, D. M., & Elkes, C. (1980). The impact on utilization of a copayment increase for ambulatory psychiatric care. Medical Care, 18(8), 807–815.

    Article  Google Scholar 

  12. Manning, W. G., Newhouse, J. P., Duan, N., Keeler, E. B., Leibowitz, A., & Marquis, M. S. (1987). Health insurance and the demand for medical care: Evidence from a randomized experiment. The American Economic Review, 77(3), 251–277.

    Google Scholar 

  13. Newhouse, J. P., & The Insurance Experiment Group. (1993). Free for all? Lessons from the RAND health experiment. Cambridge, MA: Harvard University Press.

    Google Scholar 

  14. Manning, W. G., Jr., Wells, K. B., Duan, N., Newhouse, J. P., & Ware, J. E., Jr. (1986). How cost sharing affects the use of ambulatory mental health services. Journal of the American Medical Association, 256(14), 1930–1934.

    Article  Google Scholar 

  15. Hustead, E., Sharfstein, S., Muszynski, S., Brady, J., & Cahill, J. (1985). Reductions in coverage for mental and nervous illness in the Federal Employees Health Benefits Program, 1980–1984. The American Journal of Psychiatry, 142(2), 181–186. https://doi.org/10.1176/ajp.142.2.181.

    Article  Google Scholar 

  16. Barry, C. L., Huskamp, H. A., & Goldman, H. H. (2010). A political history of federal mental health and addiction insurance parity. The Milbank Quarterly, 88(3), 404–433. https://doi.org/10.1111/j.1468-0009.2010.00605.x.

    Article  Google Scholar 

  17. Congressional Record. (2007, February 12). S1864–5. Daily edition, 153.

    Google Scholar 

  18. Buchmueller, T. C., Cooper, P. F., Jacobson, M., & Zuvekas, S. H. (2007). Parity for whom? Exemptions and the extent of state mental health parity legislation. Health Affairs, 26(4), w483–w487. https://doi.org/10.1377/hlthaff.26.4.w483.

    Article  Google Scholar 

  19. Goldman, H. H., Frank, R. G., Burnam, M. A., Huskamp, H. A., Ridgely, M. S., Normand, S. L., … Blasinsky, M. (2006). Behavioral health insurance parity for federal employees. The New England Journal of Medicine, 354(13), 1378–1386. https://doi.org/10.1056/nejmsa053737.

  20. Azrin, S. T., Huskamp, H. A., Azzone, V., Goldman, H. H., Frank, R. G., Burnam, M. A., … Moran, G. (2007). Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits Program. Pediatrics, 119(2), e452–459. https://doi.org/10.1542/peds.2006-0673.

  21. Busch, A. B., Yoon, F., Barry, C. L., Azzone, V., Normand, S. L., Goldman, H. H., & Huskamp, H. A. (2013). The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders. The American Journal of Psychiatry, 170(2), 180–187. https://doi.org/10.1176/appi.ajp.2012.12030392.

    Article  Google Scholar 

  22. Busch, A. B., Huskamp, H. A., Normand, S. L., Young, A. S., Goldman, H., & Frank, R. G. (2006). The impact of parity on major depression treatment quality in the Federal Employees’ Health Benefits Program after parity implementation. Medical Care, 44(6), 506–512. https://doi.org/10.1097/01.mlr.0000215890.30756.b2.

    Article  Google Scholar 

  23. Kirschstein, R. (2000, June). Insurance parity for mental health: Cost, access, and quality. Final Report to Congress by the National Advisory Mental Health Council. Retrieved from https://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/insurance-parity-for-mental-health-cost-access-and-quality-final-report-to-congress-by-the-national-advisory-mental-health-council.shtml. Accessed March 12, 2018.

  24. Burnam, M. A., & Escarce, J. J. (1999). Equity in managed care for mental disorders. Health Affairs, 18(5), 22–31.

    Article  Google Scholar 

  25. Essential health benefits: Individual mandate coverage. (2011, December 16). Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/basic-report/essential-health-benefits-individual-market-coverage. Accessed March 12, 2018.

  26. Horgan, C. M., Hodgkin, D., Stewart, M. T., Quinn, A., Merrick, E. L., Reif, S., … Creedon, T. B. (2016). Health plans’ early response to federal parity legislation for mental health and addiction services. Psychiatric Services, 67(2), 162–168. https://doi.org/10.1176/appi.ps.201400575.

  27. Goplerud, E. (2013, November). Consistency of large employer and group health plan benefits with requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Prepared for the Office of Disability, Aging and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/system/files/pdf/117351/mhpaeAct_0.pdf. Accessed November 13, 2017.

  28. Thalmayer, A. G., Friedman, S. A., Azocar, F., Harwood, J. M., & Ettner, S. L. (2017). The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Impact on quantitative treatment limits. Psychiatric Services, 68(5), 435–442. https://doi.org/10.1176/appi.ps.201600110.

    Article  Google Scholar 

  29. Hodgkin, D., Horgan, C. M., Stewart, M. T., Quinn, A. E., Creedon, T. B., Reif, S., & Garnick, D. W. (2018). Federal parity and access to behavioral health care in private health plans. Psychiatric Services. https://doi.org/10.1176/appi.ps.201700203.

  30. Berry, K. N., Huskamp, H. A., Goldman, H. H., & Barry, C. L. (2015). A tale of two states: Do consumers see mental health insurance parity when shopping on state exchanges? Psychiatric Services, 66(6), 565–567. https://doi.org/10.1176/appi.ps.201400582.

    Article  Google Scholar 

  31. Improving health coverage for mental health and substance use disorder patients including compliance with the federal mental health and substance use disorder parity provisions: Report to Congress. (2016, January). US Department of Labor. Retrieved from https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/mental-health-parity/parityeducationreport.pdf. Accessed March 12, 2018.

  32. Tran Smith, B., Seaton, K., Andrews, C., Grogan, C. M., Abraham, A., Pollack, H., … Humphreys, K. (2017). Benefit requirements for substance use disorder treatment in state health insurance exchanges. The American Journal of Drug and Alcohol Abuse, 1–5. https://doi.org/10.1080/00952990.2017.1411934.

  33. Ettner, S. L., Harwood, J. M., Thalmayer, A., Ong, M. K., Xu, H., Bresolin, M. J., … Azocar, F. (2016). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on expenditures among “carve-out” enrollees. Journal of Health Economics, 50, 131–143. https://doi.org/10.1016/j.jhealeco.2016.09.009.

  34. Haffajee, R. L., Mello, M. M., Zhang, F., Busch, A., Zaslavsky, A. M., & Wharam, J. F. (2017). Effects of federal mental health parity on mental health care use and spending (Working Paper).

    Google Scholar 

  35. Harwood, J. M., Azocar, F., Thalmayer, A., Xu, H., Ong, M. K., Tseng, C. H., … Ettner, S. L. (2017). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health care utilization and spending among carve-in enrollees. Medical Care, 55(2), 164–172. https://doi.org/10.1097/mlr.0000000000000635.

  36. Kennedy-Hendricks, A., Epstein, A. J., Stuart, E. A., Haffajee, R., McGinty, E. E., Busch, A. B., … Barry, C. L. (2018). Federal parity and spending for mental illness. Pediatrics, 142(2), e20172618.

    Google Scholar 

  37. Huskamp, H. A., Samples, H., Hadland, S. E., McGinty, E. E., Gibson, T. B., Goldman, H. H., … Barry, C. L. (2018). Mental health spending and intensity of service use among individuals with diagnoses of eating disorders following federal parity legislation. Psychiatric Services, 69(2), 217–223. https://doi.org/10.1176/appi.ps.201600516.

  38. Stuart, E. A., McGinty, E. E., Kalb, L., Huskamp, H. A., Busch, S. H., Gibson, T. B., & Barry, C. L. (2017). Increased service use among children with autism spectrum disorder associated with mental health parity law. Health Affairs, 36(2), 337–345. https://doi.org/10.1377/hlthaff.2016.0824.

    Article  Google Scholar 

  39. Friedman, S., Xu, H., Harwood, J. M., Azocar, F., Hurley, B., & Ettner, S. L. (2017). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders. Journal of Substance Abuse Treatment, 80, 67–78. https://doi.org/10.1016/j.jsat.2017.06.006.

    Article  Google Scholar 

  40. Walter, A. W., Yuan, Y., & Cabral, H. J. (2017). Mental health services utilization and expenditures among children enrolled in employer-sponsored health plans. Pediatrics, 139(Suppl. 2), S127–S135. https://doi.org/10.1542/peds.2016-2786G.

    Article  Google Scholar 

  41. McGinty, E. E., Busch, S. H., Stuart, E. A., Huskamp, H. A., Gibson, T. B., Goldman, H. H., & Barry, C. L. (2015). Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services. Health Affairs, 34(8), 1331–1339. https://doi.org/10.1377/hlthaff.2014.1384.

    Article  Google Scholar 

  42. Saloner, B. (2017). An update on “insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders”. Psychiatric Services, 68(3), 310–311. https://doi.org/10.1176/appi.ps.201600566.

    Article  Google Scholar 

  43. Saloner, B., Bandara, S., Bachhuber, M., & Barry, C. L. (2017). Insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders. Psychiatric Services, 68(6), 542–548. https://doi.org/10.1176/appi.ps.201600182.

    Article  Google Scholar 

  44. Thomas, K. C., Shartzer, A., Kurth, N. K., & Hall, J. P. (2018). Impact of ACA health reforms for people with mental health conditions. Psychiatric services, 69(2), 231–234. https://doi.org/10.1176/appi.ps.201700044.

    Article  Google Scholar 

  45. Saloner, B., Akosa Antwi, Y., Maclean, J. C., & Cook, B. (2018). Access to health insurance and utilization of substance use disorder treatment: Evidence from the Affordable Care Act dependent coverage provision. Health Economics, 27(1), 50–75. https://doi.org/10.1002/hec.3482.

    Article  Google Scholar 

  46. Creedon, T. B., & Cook, B. L. (2016). Access to mental health care increased but not for substance use, while disparities remain. Health Affairs, 35(6), 1017–1021. https://doi.org/10.1377/hlthaff.2016.0098.

    Article  Google Scholar 

  47. Saloner, B., Bandara, S. N., McGinty, E. E., & Barry, C. L. (2016). Justice-involved adults with substance use disorders: Coverage increased but rates of treatment did not in 2014. Health Affairs, 35(6), 1058–1066. https://doi.org/10.1377/hlthaff.2016.0005.

    Article  Google Scholar 

  48. McKenna, R. M. (2017). Treatment use, sources of payment, and financial barriers to treatment among individuals with opioid use disorder following the national implementation of the ACA. Drug and Alcohol Dependence, 179, 87–92. https://doi.org/10.1016/j.drugalcdep.2017.06.028.

    Article  Google Scholar 

  49. Kozloff, N., & Sommers, B. D. (2017). Insurance coverage and health outcomes in young adults with mental illness following the Affordable Care Act dependent coverage expansion. The Journal of Clinical Psychiatry, 78(7), e821–e827. https://doi.org/10.4088/JCP.16m11357.

    Article  Google Scholar 

  50. Golberstein, E., Busch, S. H., Zaha, R., Greenfield, S. F., Beardslee, W. R., & Meara, E. (2015). Effect of the Affordable Care Act’s young adult insurance expansions on hospital-based mental health care. The American Journal of Psychiatry, 172(2), 182–189. https://doi.org/10.1176/appi.ajp.2014.14030375.

    Article  Google Scholar 

  51. Saloner, B., & Le Cook, B. (2014). An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group. Health Affairs, 33(8), 1425–1434. https://doi.org/10.1377/hlthaff.2014.0214.

    Article  Google Scholar 

  52. Key Facts about the Uninsured Population. (2017, September). The Henry J. Kaiser Family Foundation. Retrieved from http://files.kff.org/attachment/Fact-Sheet-Key-Facts-about-the-Uninsured-Population. Accessed November 15, 2017.

  53. Final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Technical amendment to external review for multi-state plan program. Final rules. (2013). Federal Register, 78(219), 68239–68296.

    Google Scholar 

  54. Zhu, J. M., Zhang, Y., & Polsky, D. (2017). Networks in ACA marketplaces are narrower for mental health care than for primary care. Health Affairs, 36(9), 1624–1631. https://doi.org/10.1377/hlthaff.2017.0325.

    Article  Google Scholar 

  55. Dorner, S. C., Jacobs, D. B., & Sommers, B. D. (2015). Adequacy of outpatient specialty care access in marketplace plans under the Affordable Care Act. Journal of the American Medical Association, 314(16), 1749–1750. https://doi.org/10.1001/jama.2015.9375.

    Article  Google Scholar 

  56. McGuire, T. G. (2016). Achieving mental health care parity might require changes in payments and competition. Health Affairs, 35(6), 1029–1035. https://doi.org/10.1377/hlthaff.2016.0012.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Haiden A. Huskamp

Authors
  1. Haiden A. Huskamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. University of Maryland, School of Medicine, Baltimore, MD, USA

    Howard H. Goldman

  2. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Richard G. Frank

  3. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joseph P. Morrissey

Rights and permissions

Reprints and permissions

Copyright information

© 2020 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Huskamp, H.A. (2020). Mental Health Insurance Parity: How Full Is the Glass?. In: Goldman, H., Frank, R., Morrissey, J. (eds) The Palgrave Handbook of American Mental Health Policy. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-11908-9_13

Download citation

Publish with us

Policies and ethics

Search

Navigation