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The ACA attempts to overhaul certain aspects of the American health care
system with the stated goals of controlling costs, expanding insurance coverage, and improving the overall quality of care in the United States.112 The
ACA requires most American citizens and legal residents to have health insurance and is expected to result in thirty-eight million uninsured Americans obtaining insurance by 2018.113 The law creates state- or federally-based marketplaces from which individuals and small businesses can purchase coverage.114 To encourage more Americans to become insured and
more employers to provide employee health coverage, the ACA imposes
tax penalties on individuals and some employers who do not comply with
the ACA’s provisions.115 The law offers premium credits and cost-sharing
subsidies to eligible individuals and families who meet certain income
thresholds and expands certain public programs such as Medicaid.116
The ACA mandates coverage of MH and SU disorder benefits for a
number of new types of insurance plans.117 Specifically, Section 1302(b)(1)
requires that issuers offering coverage through the individual or small group
markets must cover EHBs including MH and SU disorder treatment.118
These benefits are enabled through Section 1301 of the law, which dictates
that the QHPs offered on the new ACA Exchanges include EHBs:119
Federal law for the first time is mandating mental health and substance
use disorder benefits in certain plan settings; that is, the exchange-offered
qualified health plan, the non-exchange individual health plan, the non-exchange small group health plan, the Medicaid benchmark plan, the
benchmark-equivalent plan, and the Medicaid state plan settings.120
Although HHS could have defined EHBs through regulation, the Obama
112. Summary of the Affordable Care Act, HENRY J. KAISER FAMILY FOUND., 1 (Apr. 23,
2013), http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf [hereinafter
Summary of ACA].
113. Updated Estimates of the Insurance Coverage Provisions of the Affordable Care
Act, CONG. BUDGET OFFICE (CBO) 3 (Apr. 2014), http://www.cbo.gov/sites/default/files
/cbofiles/attachments/45231-ACA_Estimates.pdf (More specifically, 25 million are expected
to obtain coverage through the Exchanges and 13 million through the expansion of Medicaid
114. PPACA, Pub. L. No. 111-148, § 1304, 124 Stat. 171-72 (2010) (codified at 42
U.S. C. § 18024); see also Summary of ACA, supra note 112.
115. Summary of ACA, supra note 112, at 1.
116. Id. at 1-2.
117. See Tovino, All Illnesses, supra note 19, at 40-42 (“[M]any health insurance plans
that were previously exempt from [providing mental health benefits at parity] are now are
prohibited from offering inferior mental health insurance benefits.”).
118. PPACA, Pub. L. No. 111-148, §1302(b)(1), 124 Stat. 163-64 (codified at 42
U.S. C. § 18022).
119. Id. at §1301 (codified at 42 U.S. C. § 18021).
120. Tovino, All Illnesses, supra note 117, at 42.