Vol. 24 Annals of Health Law 262
MHPAEA to a number of new kinds of health plans.78 Subpart A of this
section provides a brief overview of the growth of mental health parity law.
Subpart B details the MHPAEA and its enforcement mechanism. Lastly,
subpart C explores the ACA mental health mandate and its enforcement
mechanism with the ACA.
A. Historical Overview of Parity Law
Prior to the passage of mental health parity legislation, many Americans
seeking treatment for MH and SU problems faced high costs, significant
service limitations, and other formidable barriers impeding their access to
proper care.79 Some individuals turned to the courts for help, arguing that
their providers were using discriminatory coverage practices.80 However,
many courts were reluctant to strike down these policies, based on their application of contract principles to insurance plan documents.81
Efforts to achieve mental health coverage parity date back almost fifty
years, and the first legislative effort to correct the problem occurred in the
1990s.82 The Mental Health Parity Act of 1996 (“MHPA”) required group
health plans to apply the same lifetime and annual dollar limits to mental
health coverage as those applied to medical and surgical coverage.83 However, the mandate applied only to plans with fifty or more employees, and
did not require that mental health benefits be offered.84 The final form of
the law was much weaker than the original draft, and did not significantly
advance mental health parity.85 Additional legislative efforts at achieving
78. Amanda K. Sarata, Mental Health Parity and the Patient Protection and Affordable
Care Act of 2010, CONG. RES. SERV. 1, 4 (Dec. 28, 2011), available at http://www.ncsl
.org/documents/health/MHparity&mandates.pdf. See also infra Part IV for a complete discussion of the interaction between the ACA and MHPAEA.
79. See NAT’L INST. ON ALCOHOL ABUSE & ALCOHOLISM, supra note 8; See also
SUBSTANCE ABUSE & MENTAL HEALTH SERVS. ADMIN., supra note 10; See also Barry et. al.,
supra note 9; See also Nat’l Conf. of State Legs., supra note 12; See also MHPAEA § 512(a)
(codified at 29 U.S. C. § 1185(a)) (providing information about the challenges facing Americans with mental health and substance abuse illnesses.).
80. Sara Noel, Parity in Mental Health Coverage: The Goal of Equal Access to Mental
Health Treatment Under the Mental Health Parity Act of 1996 and the Mental Health Equitable Treatment Act of 2001, 26 HAMLINE L. REV. 377, 380–81 (2003).
81. See id. (discussing how courts typically only became involved in situations where
the beneficiary believed he was wrongly denied coverage because his illness had been misclassified as a mental condition, rather than a physical one).
82. Barry et al., supra note 9, at 408–09.
83. Mental Health Parity Act of 1996, Pub. L. No. 104-204, sec. 701-03, 110 Stat.
29442874 (codified as amended at 29 U.S. C. § 1185a (2009)) [hereinafter MHPA].
84. Barry et al., supra note 9, at 409.
85. Kessler, supra note 19, at 153–54. See also Sarah Goodell, Health Affairs Policy
Brief, Mental Health Parity 1 (Apr. 3, 2014), available at http://healthaffairs.org/health
policybriefs/brief_pdfs/healthpolicybrief_112.pdf (noting that the final version of the law
“did not address treatment limits, limitations on the types of facilities covered, differences in