Vol. 24 Annals of Health Law 278
issues, driven in part by improperly treated mental illnesses, brought the issue of MH to the public’s attention—perhaps more than ever before.202 The
ACA and MHPAEA parity promise could potentially help millions with
these diseases, finally “putting our brains on the same level” as the rest of
our bodies.203 However, this goal can only be accomplished if coverage-parity exists and is properly enforced by federal and state enforcement authorities working together.
In order to understand how to enforce the parity mandate through the
ACA, one must first understand how QHPs, EHBs, and Exchanges operate
and relate to one another under the ACA. The ACA requires the establishment of an Affordable Insurance Exchange in each state to begin operating
on January 1, 2014.204 States are free to set up and operate their own Exchanges, but are not required to do so.205 Instead, a state may partner with
the federal government to establish a Partnership Exchange, or if a state
elects not to create its own marketplace, then the HHS will operate a FFE in
The healthcare marketplace will offer consumers and small business
owners their choice of a number of QHPs.207 In order for an insurance plan
to qualify as a QHP, it must include coverage for a number of EHBs mandated by the ACA and standardized by each state’s EHB-base benchmark
plan.208 These benchmark plans, and subsequently, any QHP, must provide
discussing the 2012 Aurora, Colorado theater shooting and its impact on mental health care reform).
202. Letter from A. Thomas McClellan, Founder and CEO, Treatment Research Inst.
(June 3, 2014) (on file with author) (stating that “we are at a watershed moment in behavioral health. Public awareness about addiction and mental illness is growing, legislative advances have brought us ever close to parity and integrated care, and the research base is expanding so that we can better address the social and biological determinants of these
203. PATRIO TS FOR PARITY, supra note 148, at 10.
204. PPACA, 42 U.S. C. A. § 18031 (West, Westlaw through P.L. 113-174 approved
Sept. 26, 2014).
205. Id. at § 18041.
206. See State Decisions for Creating Health Insurance Marketplaces, KAISER FAM.
FOUND (2014), http://kff.org/health-reform/state-indicator/health-insurance-exchanges/ (
stating that there currently are fourteen state-based marketplaces; seven partnership marketplaces; and twenty-seven federally facilitated marketplaces).
207. See 42 U.S. C. A. § 300gg-6 (West, Westlaw through P.L. 113-174 approved Sept.
26, 2014) (“ A health insurance issuer that offers health insurance coverage in the individual
or small group market shall ensure that such coverage includes the essential health benefits
package required under section 1302(a) of the Patient Protection and Affordable Care Act.”).
208. See 45 C.F.R. § 156.20 (West, Westlaw through Nov. 4, 2014; 79 FR 68087); 45
C.F.R. §156.100 (West, Westlaw through Nov. 4, 2014; 79 FR 68087); 45 C.F.R. §156.110
(West, Westlaw through Nov. 4, 2014; 79 FR 68087). Benchmark plans define essential