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This paper identifies a critical failure in U.S. mental-health insurance regulation, and proposes a solution. The 2008 federal Mental Health Parity law required “parity” in coverage for mental health benefits. But, it permitted insurers to opt out of providing any mental health insurance benefits at all — which many did. The Affordable Care Act (Obamacare), in contrast, requires mental health coverage for all plans sold through Exchanges. Yet, the federal government has continued to defer authority to states and insurers to define what that coverage should be resulting in sub-par mental health coverage. We reviewed the “benchmark” standards put in place by all 50 states in response to the ACA and found broad variability in mental health inclusions, exclusions and limitations. Currently, these laws are siloed. We argue that the laws, if enforced together, would assure true parity in mental health care coverage and offer concrete steps for regulators can take to do this. As a first step, we propose that the federal government use its regulatory authority to identify a minimum standard for mental health benefits to address the variability found in our review of state standards. Timing for this solution is urgent as federal regulators have a narrow window in the next year and a half to adjust Obamacare plans to provide a more robust mental health benefit upon which more standardized federal and state enforcement could take place.

Enforcing Mental Health Parity Through the Affordable Care Act's Essential Health Benefit Mandate