Biden Calling ACA ‘Breakthrough’ For Mental Health Parity Highlights Gaps

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“We made parity between mental health and physical health,” Biden told CNN’s Chris Cuomo. “It was a fundamental breakthrough in how we thought about how things should work.”

This gets at a health care issue that — as a federal appeals court weighs Obamacare’s constitutionality — is now particularly relevant. Did the ACA create equal coverage of mental and physical health?

We decided to investigate. We contacted the Biden campaign and never heard back.

But our own reporting shows that while Biden’s claim is mostly accurate concerning the health law’s provisions, its implementation has yet led to trigger the systemwide changes necessary to achieve the goal of parity.

One Problem, Two Laws

The ACA, which became law in 2010, does include provisions meant to strengthen access to and insurance coverage of mental health care. But it wasn’t the first statute to take on this challenge.

Two years earlier, before Barack Obama became president, Congress passed the Mental Health Parity and Addiction Equity Act. It said that if insurance offered by large employers — an organization employing more than 50 people — included mental health benefits, it had to structure those benefits, as well as associated copayments or caps on visits, equal to — “at parity” with — physical health benefits.

A key thing to note, though, is that this 2008 law did not specifically mandate coverage of mental health services.

Obamacare went further by requiring most plans to cover mental health and substance abuse. And it extended the parity requirement beyond large-employer-sponsored coverage to plans offered by small employers and those bought on the individual market.

Health economists estimate that the ACA extended mental health benefits to 62 million people.

“It substantially expanded the reach of the parity law,” said Sherry Glied, a health economist and dean at New York University.

Both Glied and Richard Frank, a health economics professor at Harvard University, agreed that the first part of Biden’s claim checks out. The health law certainly brought in new standards for parity and expanded the rules already on the books. (Frank and Glied both served in the Obama administration.)

But the law also operates in tandem with the earlier legislation. One could reasonably question whether it constitutes a “fundamental breakthrough” or represents the next step in a broader trajectory.

“Improving Health Coverage for Mental Health and Substance Use Disorder Patients,” January 2016.

Journal of Social Work in Disability & Rehabilitation, “Behavioral Health Parity and the Affordable Care Act,” May 2, 2014.

Health Affairs, “Federal Parity in the Evolving Mental Health And Addiction Care Landscape,” June 2016.

Kaiser Health News, “Advocates Say Mental Health ‘Parity’ Law Is Not Fulfilling Its Promise,” Aug. 3, 2015.

Kaiser Health News, “Narrow Networks Get Even Tighter When Shopping for Mental Health Specialists,” Sept. 22, 2017.

Hastings Science and Technology Law Journal, “Mental Health Parity: The Patient Protection and Affordable Care Act and the Parity Definition Implications,” summer 2014.

Telephone interview with Richard Frank, Margaret T. Morris Professor of Health Economics at Harvard Medical School, July 9, 2019.

Telephone interview with Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, July 9, 2019.

Telephone interview with JoAnn Volk, a research professor at Georgetown University Center on Health Insurance Reforms, July 10, 2019.