The Importance of Parity in Mental Health

par·i·ty– noun- The state or condition of being equal, especially in regarding status and pay. 

Every since the 2016 American presidential elections, I’ve been interested in how laws work and how they get passed, specifically in regards to mental health. Despite being thoroughly invested in the psychological and sociological aspects of mental health, I never was interested in how policy affected mental health and those battling mental illness, until now. Two laws I will explore is the 1996 Mental Health Parity Act and the 2008 Paul Wellstone Mental Health Parity and Addiction Equality Law.

These parity laws were established because traditionally employers and insurers covered mental health differently from treatment with physical conditions. Often mental health treatment had its own coverage, often higher costs, and a more restrictive number of inpatient and outpatient visits. Also, it had separate yearly and lifetime caps on coverage and different prior authorization requirements than coverage for other medical care.

Advocated by Senators Paul Wellstone (D-MN) and Pete Domenici (R-NM) 1996, Congress enacted the Mental Health Parity Act (MHPA). The 1996 Mental Health Parity Act was a beginning step to leveraging the ground between mental health costs and physical health costs. This law applied to employer-sponsored health care plans ( those with more than 50 employees) and banned them from imposing higher yearly or lifetime dollars on mental health benefits than those applicable to medical or surgical benefits. This law also applied to fully insured group health plans (plans who purchased insurance from an insurance company or issuer) and self-insured group health plans ( plans that retained financial risk for health care claims).

Even though MHPA was a step in the right direction, there were many loopholes. The act did not discuss treatment limits, limitations of the types of facilities covered, differences in cost sharing, and the application of managed care techniques that still made mental health benefits less ample than other health benefits. An example is that a plan could set a limit of ten visits for therapy to treat anxiety or charge a higher co-pay for an outpatient visit for mental health treatment than for a physical issue without breaching the law.

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA). Similar to the MHPA, the requirements applied to large group health plans, both fully and self-insured. The difference is that the MHPAEA blocked the differences in treatment limits, cost-sharing, and in-and out-of-network sharing. Furthermore, MHPAEA addressed substance use disorders, wherein the previous law did not.

Even though mental health stigma is still alive and well, I’m glad policies like the Mental Health Parity Act and the Mental Health Parity and Equity Act are being passed. They help decrease the gap between physical and mental health conditions and the mental health stigma.