ABSTRACT
[...]this Note argues that health insurers should take a more meaningful role in complying with and promoting mental health well-being. By the 1980s, any progress made up to that point was soon after undetectable.24 President Bill Clinton later considered mental health parity during his healthcare reform efforts in 1993,25 but these efforts were equally unsuccessful.26 It was only in 1996 that Senators Pete Domenici and John Danforth introduced the first round of momentous federal parity legislation known as The Mental Health Parity Act of 1996 (MHPA).27 Although the MHPA was a compromised version of the more extensive 1992 Domenici-Wellstone bill, it nonetheless was the first of its kind and a sign of things to come.28 According to the MHPA, insurers were prohibited from imposing disparate annual and lifetime limits for mental health benefits when compared to surgical and medical benefits as offered by a group health plan or health insurance issuer offering coverage in connection with a group health plan.29 While this meant that insurers could no longer stymie access to mental health services by providing unequal coverage under a plan, the MHPA contained certain important exceptions. Rather, it only applied to group health plans that offered mental health benefits at the outset, and it did not apply to employers with fewer than 50 employees.30 Moreover, insurers were free to charge different copays and coinsurance rates.31 Lastly, employers could request exempt status from any requirements if they could show a one percent increase in premiums.32 a. The Mental Health Parity and Addiction Equity Act To combat the vast shortcomings of the MHPA,33 Congress eventually passed the Mental Health Parity and Addiction Equity Act in 2008 (MHPAEA).34 This newly enacted law prohibited differences in treatment options as well as certain cost-sharing schemes insurers previously engaged in under the MHPA. [...]according to the MHPA, insurers could set daily limits on outpatient mental health services, set their own coinsurance rates (including co-pays, deductibles, and out-of-pocket maximums), and limit treatment benefits irrespective of any parity considerations.35 Nonetheless, despite these additional requirements, the MHPAEA did not require that health insurers provide coverage for any type of mental health services.36 b. The Affordable Care Act Beyond providing health care for 20 million previously uninsured Americans, the Affordable Care Act (ACA) set the stage for what would become the largest development in access to mental health services this country has ever seen.37 Most notably, the ACA defined "mental health and substance use treatment" as an essential health benefit (EHB)38 and required individual and small-group plans to cover all EHBs.39 As previously noted, the MHPAEA only applied to large employers (50 or more employees) and only if they chose to provide mental health coverage.