Cited by 162Healthcare Policy and ManagementHealth, Medicine and SocietyMental Health Treatment and Access

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A Political History of Federal Mental Health and Addiction Insurance Parity

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BARRY, COLLEEN L., HUSKAMP, HAIDEN A., GOLDMAN, HOWARD H.·2010·Milbank Quarterly

DOI 10.1111/j.1468-0009.2010.00605.xPMC PMC2950754

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Abstract

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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Authors: BARRY, C. L., HUSKAMP, H. A., & GOLDMAN, H. H.
Affiliations: Harvard University (US)
Corresponding author: BARRY, COLLEEN L.
ORCID: BARRY, COLLEEN L.
HUSKAMP, HAIDEN A.
GOLDMAN, HOWARD H.
Venue: Milbank Quarterly
Publisher: Wiley
Published: 2010-09-22
Volume: 88
Issue: 3
Pages: 404-433
ISSN: 0887-378X (ISSN-L)
DOI: 10.1111/j.1468-0009.2010.00605.x
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
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1805 d)
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
Health Sciences › Medicine › Psychiatry and Mental health › 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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A Political History of Federal Mental Health and Addiction Insurance Parity

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