Health & Spirit

Fact check: Biden calling ACA 'breakthrough' for mental health parity highlights gaps

Shefali Luthra, Kaiser Health News on

Published in Health & Fitness

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.


Perhaps more important, though, is the current state of parity. To be sure, the ACA's requirements created a clear set of parity standards. In some respects, though, these standards exist on paper but don't always play out in practice.


"It's huge that the guaranteed protections are there," said JoAnn Volk, a research professor at Georgetown University. "The challenges remain in delivering on them."

That's because some coverage inequities are easier to spot than others. If a health plan caps how many times you can see a psychiatrist but doesn't do so for an allergist or oncologist, that's a clear violation. If mental health care visits have higher coinsurance than do physical health visits, that's also obviously illegal.

Evidence suggests those quantitative barriers are less common now than they were before the passage of these two laws. Those changes, Glied said, have most clearly benefited people with severe psychiatric conditions.

But other barriers remain -- many of which are quite nuanced and therefore more difficult to spot and enforce.


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