Enforcing Mental Health Parity Through the
Affordable Care Act’s Essential Health Benefit
Kathleen G. Noonan† and Stephen J. Boraske‡
“So many people have worked so many years to get us this far, but we
are starting all over again. The new mission is oversight and implementation and enforcement of MHPAEA.” Patrick J. Kennedy, Former U.S.
Congressman (December 6, 2013).
In recent years, advocates for expanded mental health benefits secured
two successes in fundamental coverage.1 First, Congress enacted the Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity
Act (“MHPAEA”)2 in 2008, ushering in new, equitable insurance protections for Americans with mental health (“MH”) and substance use (“SU”)
disorder afflictions. Second, in 2010 the Patient Protection and Affordable
Care Act (“ACA”)3 expanded health insurance coverage to millions of uninsured Americans and required that any health plans sold on the newly created insurance federal and state marketplaces (the “marketplace”) include
mental health and substance abuse coverage as “essential health benefits
Before the enactment of these laws, the federal government deferred to
state insurance commissioners and payers on whether and how mental
The authors wish to thank Professors Stacy Tovino and Jonathan Lipson for their
thoughtful review of our paper, Dorothy Miller for advice and research support, and Leigh
Wilson for fact checking.
† Faculty, University of Pennsylvania, Master in Public Health Program and Co-Director, PolicyLab, The Children’s Hospital of Philadelphia.
‡ Legal Intern, PolicyLab, The Children’s Hospital of Philadelphia, J. D. candidate 2015,
Temple Law School.
1. See Emergency Economic Stabilization Act of 2008, Pub L. No. 110-343, sec. 511–
12, 122 Stat. 3756, 3881–92 (codified as amended at 29 U.S. C. § 1185a (2009) and 42
U.S. C. § 300gg-26 (2008)) [hereinafter MHPAEA or the parity law]. See also Patient Protection and Affordable Care Act, Pub L. No. 111-148, 124 Stat. 119 (2010) (codified as amended in scattered sections of U.S. C.) [hereinafter ACA or the healthcare law].
2. MHPAEA § 511-512.
3. ACA, 124 Stat. 119.
4. Id. §1302(b)(1) (codified at 42 U.S. C. § 18022).