Equality Standards for Health Insurance Coverage: Will the Mental Health Parity and Addiction Equity Act End the Discrimination?

Congress enacted the Mental Health Parity and Addiction Equity Act in 2008 to end discriminatory health insurance coverage for persons with mental health and substance use disorders in large employer health plans. Adopting a comprehensive regulatory approach akin to other civil rights laws, the Parity Act requires “equity” in all plan features, including cost-sharing, durational limits and, most critically, the plan management practices that are used to deny many families medically necessary behavioral health care. Beginning in 2014, all health plans regulated by the Affordable Care Act must also comply with parity standards, effectively ending the second-class insurance status of persons with these disorders. With the legal framework in place, this Article examines whether the Parity Act will achieve its promise of equitable health care coverage. It concludes that two structural features—the complexity of the Act’s standards and the health plan’s control of all data needed to assess compliance—render enforcement by consumers exceedingly difficult. Enforcement is further jeopardized by the federal regulators’ failure to articulate a standard to implement the most fundamental aspect of the law—the required scope of behavioral health services—and to provide sufficient guidance on the law’s most contentious provision—regulation of plan management practices. To address these enforcement limitations, the Article provides a detailed explanation of the Parity Act’s standards, offers interpretive guidance to resolve key questions and recommends implementation strategies to enhance consumer notification and demonstration of parity compliance. Additional, yet modest, compliance requirements are needed to ensure that the Parity Act achieves its remedial goal