A political history of federal mental health and addiction insurance parity
Open accessAbstract
CONTEXT: This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades. METHODS: Twenty-nine structured interviews were conducted with key informants in the federal parity debate, including members of Congress and their staff; lobbyists for consumer, provider, employer, and insurance groups; and other key contacts. Historical documentation, academic research on the effects of parity regulations, and public comment letters submitted to the U.S. Departments of Labor, Health and Human Services, and Treasury before the release of federal guidance also were examined. FINDINGS: Three factors were instrumental to the passage of this law: the emergence of new evidence regarding the costs of parity, personal experience with mental illness and addiction, and the political strategies adopted by congressional champions in the Senate and House of Representatives. CONCLUSIONS: Challenges to implementing the federal parity policy warrant further consideration. This law raises new questions about the future direction of federal policymaking on behavioral health.
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Forty-five states enacted some form of parity law, but only five states included SUD benefits in their parity laws.
“Forty-five states enacted some form of parity law, although different conditions, benefits, and employer groups were included in each of the mandates (Sturm & Pacula, 1999). Notably, only five states included SUD benefits in their parity laws (Barry, Huskamp, & Goldman, 2010).”
From The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders (2017) · cites this paper as Barry, Huskamp, & Goldman, 2010
In “The Early Years > Federal Impasse on Parity” (page unavailable), the paper says only a handful of states covered treatment for substance use disorders, supporting the general point but not the exact count of five. The 45-state figure is attached to Sturm and Pacula in the citing sentence, not to this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBefore MHPAEA, state and federal attempts to improve equity of employer-sponsored behavioral health coverage did not match MHPAEA's inclusivity of SUD benefits.
“Before MHPAEA, state and federal attempts to improve equity of employer-sponsored BH coverage did not match MHPAEA's inclusivity of SUD benefits.”
From The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders (2017) · cites this paper as Barry, Huskamp, & Goldman, 2010
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- Authors
- BARRY, C. L., HUSKAMP, H. A., & GOLDMAN, H. H.
- Affiliations
- Harvard University (US)
- Corresponding author
- BARRY, COLLEEN L.
- Venue
- Milbank Quarterly
- Publisher
- Wiley
- Published
- 2010-09-22
- Volume
- 88
- Issue
- 3
- Pages
- 404-433
- ISSN
- 0887-378X (ISSN-L)
- PMC
- PMC2950754
- OpenAlex
- W2160959952
- Cited by
- 162
- References
- 35
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 1 · 2020: 5 · 2019: 8 · 2018: 8 · 2017: 51 · 2016: 12 · 2015: 8 · 2014: 5 · 2013: 5 · 2012: 13
- FWCI
- 16.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Milbank Quarterly (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH080797, R01MH093414)
- National Institute on Drug Abuse (R01DA026414)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- mental health parity, private health insurance, legislative politics, lobbying, mental illness, addiction treatment, health policy implementation
- MeSH terms
- Humans, Income, Insurance, Health, Interviews as Topic, Mental Health, Politics, Social Justice, Socioeconomic Factors, United States, Substance-Related Disorders, Health Status Disparities
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