By Les Kertay, PhD

Senior Medical Consultant
R3 Continuum

Recently, mental health parity dodged a bullet, along with the Affordable Care Act (ACA). But what happens next remains uncertain. Here’s why it matters to the nation, and why employers should care.

In 1996, the Mental Health Parity Act (MHPA) first mandated MHP in group health insurance. The MHPA applied to employer-sponsored group health plans with 50 employees or more. It was a good step toward improving access to mental health care, but it didn’t mandate mental health benefits, instead only preventing different fee structures if mental health benefits were offered. In addition, it was relatively easy for employers to argue a financial hardship, and so qualify for an exemption. It made little practical difference, ultimately. For all that it was a bellwether, few additional benefits were actually made available on a federal level.

Nevertheless, from 1991 through 2008, a dozen states introduced state-level versions of parity, with a surprising outcome; in most states, total health expenditures went up, but not nearly as much as was feared. In a few, total costs actually went down. That helped to pass the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, closing some of the MHPA loopholes, and extending parity to substance abuse treatment. It still didn’t require that treatment be offered, and there was a hidden exception that allowed insurers to use non-financial strategies — such as differing standards for utilization review — to put tighter controls on mental health spending.

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