Federal Efforts to Achieve Mental Health Parity: A Step in the Right Direction, But Discrimination Remains

Prior to the 1970s, many healthcare plans in the U.S. offered benefits without discriminating between mental health and general healthcare coverage. In the 1970s and 1980s, the cost of healthcare increased dramatically and employers eliminated or limited mental health benefits in an attempt to reduce insurance costs. To manage insurance costs, employers began using more cost sharing mechanisms and benefit caps on mental health benefits. However, these limitations were not applied equally to mental health and general health benefits and a coverage disparity was created. Today, insurers often do not provide coverage for mental health on the same terms as general health. Patients with mental illness face disability, dependence on social programs, incarceration, and homelessness, while the mental healthcare system remains separate from, and inferior to, the greater healthcare system. Private health insurance plans continue to discriminate against patients with mental illness and generally provide mental health coverage that is inferior in comparison to general healthcare coverage. Unfortunately, mental illness remains on the fringes of the healthcare system, especially as it relates to access to medical treatment. Accordingly, the goal of the mental health parity movement is to require insurers to provide coverage for mental health on the same basis as general health. The term “Mental health parity”, generally means that insurance coverage for mental health services are subject to the same terms and restrictions as coverage for all other health services. With this goal in mind, this article will provide a brief history of how the current inequality in mental health insurance coverage developed. Second, this article will examine the current debate around mental health parity and will consider arguments from opponents and proponents. Next, this article will examine and evaluate the effectiveness of state and federal parity legislation, including the Mental Health Parity Act of 1996, the Mental Health Parity and Addiction Equality Act of 2008 and the Patient Protection and Affordable Care Act of 2010. Finally, this article will advocate for additional parity protections and propose comprehensive federal parity legislation