Recently, the federal government has taken numerous steps to promote the equal treatment (also known as parity) of mental and physical health issues. The two most impactful actions are the Mental Health Parity and Addiction Act of 2008 and the Affordable Care Act. These acts focus on the traditional avenue for parity change—insurance regulation. While these acts have improved parity, major gaps in coverage and treatment between mental health/substance use disorder treatment and medical/surgical treatment persist. ERISA Preemption, evasive insurer behavior, lack of enforcement, and lack of consumer education continue to plague patients and healthcare professionals. On its own, federal insurance regulation is not doing its job. While the extent of the problem varies by state, the United States is nowhere close to full mental health parity.

Nonetheless, the push towards full parity continues at the state level. This Comment analyzes the parity efforts of four states: Illinois, Massachusetts, Delaware, and Pennsylvania. Each state represents a different approach to mental health parity. While some states focus on traditional insurance regulation, others enact broad changes that address specific practical and social challenges in behavioral health care. This Comment will analyze each state’s actions beyond typical parity metrics and consider the holistic impact of the state’s actions on the entire behavioral health system. Ultimately, this Comment will make two major recommendations. First, federal and state governments must broaden their view of parity to include implicit barriers to care outside of insurance coverage and treatment rates. Second, true parity requires states to pair stringent insurance regulation with community sourced action plans designed to mitigate current issues in the behavioral health system.



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