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Coverage mandates and market dynamics: employer, insurer and patient responses to parity laws

Published online by Cambridge University Press:  12 October 2018

Robert A. Nathenson Open the ORCID record for Robert A. Nathenson [Opens in a new window]
Robert A. Nathenson*
Affiliation:
Research Specialist, Consortium for Policy Research in Education, University of Pennsylvania, Graduate School of Education, Philadelphia, PA, USA
*
*Correspondence to: Robert A. Nathenson, Research Specialist, Consortium for Policy Research in Education, University of Pennsylvania, Graduate School of Education, 3440 Market Street, Suite 500, Philadelphia, PA19104, USA. Email: robert.nathenson@gmail.com
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Abstract

Parity in coverage for mental health services has been a longstanding policy aim at the state and federal levels and is a regulatory feature of the Affordable Care Act. Despite the importance and legislative effort involved in these policies, evaluations of their effects on patients yield mixed results. I leverage the Employee Retirement Income Security Act and unique claims-level data that includes information on employers’ self-insurance status to shed new light in this area after the implementation of two state parity laws in 2007 and federal parity a few years later. My empirics reveal evidence of strategic avoidance on behalf of insurers in both states prior to the passage of state parity, as well as positive increases in mental health care utilization after parity laws are implemented – but context matters. Policy heterogeneity across states and strategic behaviors by employers and commercial insurers substantively shape the benefits that ultimately flow to patients. Insights from this research have broad relevance to ongoing health policy debates, particularly as states retain great discretion over many health coverage decisions and as federal policy continues to evolve.

Keywords

mental healthState and Federal parity lawshealth insuranceself-insuranceMHPAEA
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 2 , April 2020 , pp. 173 - 195
Copyright
© Cambridge University Press 2018

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References

45 Code of Federal Regulations (CFR) §156.110(f). https://www.law.cornell.edu/cfr/text/45/156.110.Google Scholar
45 Code of Federal Regulations (CFR) §156.122. https://www.law.cornell.edu/cfr/text/45/156.122.Google Scholar
Anda, R, Williamson, D, Escobedo, L, Mast, E, Giovino, G and Remington, P (1990) Depression and the dynamics of smoking. JAMA 264, 1541–1545.CrossRefGoogle ScholarPubMed
Andersen, M (2015) Heterogeneity and the effect of mental health parity mandates on the labor market. Journal of Health Economics 43, 74–84.CrossRefGoogle ScholarPubMed
Atzerma, CL, Schull, MJ and Tu, JV (2011) The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction. CMAJ 183(6): 663–669.CrossRefGoogle Scholar
Azrin, ST, Huskamp, HA, Azzone, V, Goldman, HH, Frank, RG, Burnam, MA, Normand, ST, Ridgely, MS, Young, AS, Barry, CL, Busch, AB and Moran, G (2007) Impact of full mental health and substance abuse parity for children in the federal employees health benefits program. Pediatrics 119, e452–e459.CrossRefGoogle ScholarPubMed
Bao, Y and Sturm, R (2004) The effects of state mental health parity legislation on perceived quality of insurance coverage, perceived access to care, and use of mental health specialty care. Health Services Research 39(5): 1361–1377.CrossRefGoogle ScholarPubMed
Barry, CL and Busch, SH (2007) Do state parity laws reduce the financial burden on families of children with mental health care needs? Health Services Research 42(3): 1061–1084.CrossRefGoogle ScholarPubMed
Barry, CL and Ridgely, MS (2008) Mental health and substance abuse insurance parity for federal employees: how did health plans respond? Journal of Policy Analysis and Management 27(1): 155–170.CrossRefGoogle ScholarPubMed
Barry, CL, Frank, RG and McGuire, TG (2006) The costs of mental health parity: still an impediment? Health Affairs 25(3): 623–634.CrossRefGoogle ScholarPubMed
Barry, CL, Huskamp, HA and Goldman, HH (2010) A political history of federal mental health and addiction insurance parity. Milbank Quarterly 88(3): 404–433.CrossRefGoogle ScholarPubMed
Barry, CL, Gabel, JR, Frank, RG, Hawkins, S, Whitmore, HH and Pickreign, JD (2003) Design of mental health benefits: still unequal after all these years. Health Affairs 22(5): 127–137.CrossRefGoogle ScholarPubMed
Bartels, SJ (2004) Caring for the whole person: integrated health care for older adults with severe mental illness and medical comorbidity. Journal of the American Geriatric Society 52(12 Supplement): S249–S257.CrossRefGoogle ScholarPubMed
Beronio, K, Glied, S, Po, R and Skopec, L, ASPE (2013) Affordable Care Act Will Expand Mental Health and Substance Use Disorder Benefits and Parity Protections for 62 Million Americans, Washington, DC: Department of Health & Human Services.Google Scholar
Berry, KN, Huskamp, HA, Goldman, HHBarry, CL (2015) A tale of two states: do consumers see mental health insurance parity when shopping on state exchanges? Psychiatric Services 66(6): 565-567.CrossRefGoogle Scholar
Björkenstam, E, Ljung, R, Burström, B, Mittendorfer-Rutz, E, Hallqvist, J and Ringbäck Weitoft, G (2012) Quality of medical care and excess mortality in psychiatric patients – a nationwide register-based study in Sweden. BMJ Open 2(e000778): 1–10.CrossRefGoogle ScholarPubMed
Breslau, N, Peterson, EL, Schultz, LR, Chilcoat, HD and Andreski, P (1998) Major depression and stages of smoking: a longitudinal investigation. Archives of General Psychiatry 55(2): 161–166.CrossRefGoogle ScholarPubMed
Buchmueller, TC, Cooper, PF, Jacobson, M and Zuvekas, SH (2007) Parity for whom? Exemptions and the extent of state mental health parity legislation. Health Affairs 26(4): w483–w487.CrossRefGoogle ScholarPubMed
Burns, ME (2015) State discretion over Medicaid coverage for mental health and addiction services. Psychiatric Services 66(3): 221–223.CrossRefGoogle ScholarPubMed
Burstein, P (2003) The impact of public opinion on public policy: a review and an agenda. Political Research Quarterly 56(1): 29–40.CrossRefGoogle Scholar
Busch, AB, Frank, RG and Lehman, AF (2004) The effect of a managed behavioral health carve-out on quality of care for Medicaid patients diagnosed as having schizophrenia. Archives of General Psychiatry 61(5): 442–448.CrossRefGoogle ScholarPubMed
Busch, AB, Frank, RG, Lehman, AF and Greenfield, SF (2006) Schizophrenia, co-occurring substance use disorders and quality of care: the differential effect of a managed behavioral health care carve-out. Administration and Policy in Mental Health and Mental Health Services Research 33(3): 388–397.CrossRefGoogle ScholarPubMed
Busch, AB, Yoon, F, Barry, CL, Azzone, V, Normand, S-LT, Goldman, HH and Huskamp, HA (2013) The effects of mental health parity on spending and utilization for bipoloar, major depression, and adjustment disorders. American Journal of Psychiatry 170, 180–187.CrossRefGoogle Scholar
Busch, SH and Barry, CL (2008) New evidence on the effects of state mental health mandates. Inquiry 45(3): 308–322.CrossRefGoogle ScholarPubMed
Busch, SH, Epstein, AJ, Harhay, MO, Fiellin, DA, Un, H, Leader, D JrBarry, CL (2014) The effects of federal parity on substance use disorder treatment. American Journal of Managed Care 20(1): 76–82.Google ScholarPubMed
Busching, D and Kapochunas, S (2009) Timothy’s law: introducing New York to mental health parity. Hofstra Labor & Employment Law Journal 25, 601–638.Google Scholar
Cai, X and Li, Y (2013) Are AMI patients with comorbid mental illness more likely to be admitted to hospitals with lower quality of AMI care? PLoS One 8(4): e60258.CrossRefGoogle ScholarPubMed
Cauchi, R, Hanson, K, Landess, S and Thangasamy, A (2015) Mental health benefits: state laws mandating or regulating. National Conference of State Legislatures, http://www.ncsl.org/research/health/mental-health-benefits-state-mandates.aspx#3 [7 August 2018].Google Scholar
Center for Consumer Information & Insurance Oversight (2018). Information on Essential Health Benefits (EHB) Benchmark Plans. Baltimore, MD. Centers for Medicare & Medicaid Services, https://www.cms.gov/cciio/resources/data-resources/ehb.html [7 August 2018].Google Scholar
Dave, D and Mukerjee, S (2011) Mental health parity legislation, cost-sharing and substance-abuse treatment admissions. Health Economics 20, 161–183.CrossRefGoogle ScholarPubMed
Department of Consumer & Business Services (2007–2013 Annual Reports) Health Insurance in Oregon.Google Scholar
Desai, MM, Rosenheck, RA, Druss, BG and Perlin, JB (2002) Mental disorders and quality of diabetes care in the veterans health administration. American Journal of Psychiatry 159(9): 1584–1590.CrossRefGoogle ScholarPubMed
Druss, BG and Newcomber, JW (2007) Challenges and solutions to integrating mental and phsyical health care. Journal of Clinical Psychiatry 68(4): e09.Google Scholar
Druss, BG, Rohrbaugh, RM, Levinson, CM and Rosenheck, RA (2001) Integrated medical care for patients with serious psychiatric illness: a randomized trial. JAMA Psychiatry 58(9): 861–868.Google ScholarPubMed
Druss, BG, Rosenheck, RA, Desai, MM and Perlin, JB (2002) Quality of preventive medical care for patients with mental disorders. Medical Care 40(2): 129–136.CrossRefGoogle ScholarPubMed
Druss, BG, Zhao, L, Von Esenwein, S, Morrato, EH and Marcus, SC (2011) Understanding excess mortaility in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical Care 49(6): 599–604.CrossRefGoogle Scholar
Federal Register (2013) Final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 78(219), https://www.gpo.gov/fdsys/pkg/FR-2013-11-13/pdf/2013-27086.pdf [7 August 2018].Google Scholar
Federal Register (2018) Short-term, limited-duration insurance, 83, 7437, https://www.federalregister.gov/documents/2018/02/21/2018-03208/short-term-limited-duration-insurance [7 August 2018].Google Scholar
Frank, RG and Garfield, RL (2007) Managed behavioral health care carve-outs: past performance and future prospects. Annual Review of Public Health 28, 303–320.CrossRefGoogle ScholarPubMed
Frank, RG, Koyanagi, C and McGuire, TG (1997) The politics and economics of mental health ‘parity’ laws. Health Affairs 16(4): 108–119.CrossRefGoogle ScholarPubMed
Fronstin, P (2012) Self-insured health plans: state variation and recent trends by firm size. Washington, DC: ERBI Education and Research Fund.Google Scholar
Glassman, AH, Covey, LS, Stetner, F and Rivelli, S (2001) Smoking cessation and the course of major depression: a follow-up study. Lancet 357(9272): 1929–1932.CrossRefGoogle ScholarPubMed
Glassman, AH, Helzer, JE, Covey, LS, Cottler, LB, Stetner, F, Tipp, JE and Johnson, J (1990) Smoking, smoking cessation, and major depression. JAMA 264(12): 1546–1549.CrossRefGoogle ScholarPubMed
Harris, KM, Carpenter, C and Bao, Y (2006) The effects of state parity laws on the use of mental health care. Medical Care 44(6): 499–505.CrossRefGoogle ScholarPubMed
Horvitz-Lennon, M, Kilbourne, AM and Pincus, HA (2006) From silos to bridges: meeting the general health care needs of adults with severe mental illness. Health Affairs 25(3): 659–669.CrossRefGoogle Scholar
Insel, TR (2008) Assessing the economic costs of serious mental illness. American Journal of Psychiatry 165(6): 663–665.CrossRefGoogle ScholarPubMed
Kaiser Family Foundation (2017) 2017 Employer Health Benefits Survey Section 13: Grandfathered Health Plans, https://www.kff.org/report-section/ehbs-2017-section-13-grandfathered-health-plans/#figure131 [7 August 2018].Google Scholar
Kessler, RC, Heeringa, S, Lakoma, MD, Petukhova, M, Rupp, AE, Schoenbaum, M, Wang, PS and Zaslavsky, AM (2008) The individual-level and societal-level effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication. American Journal of Psychiatry 165(6): 703–711.CrossRefGoogle Scholar
Lang, M (2013) The impact of mental health insurance laws on state suicide rates. Health Economics 22, 73–88.CrossRefGoogle ScholarPubMed
Lawrence, D and Kisely, S (2010) Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology 24(11 Supplement 4): 61–68.CrossRefGoogle ScholarPubMed
McConnell, KJ (2013) The effect of parity on expenditures for individuals with severe mental illness. Health Services Research 48(5): 1634–1652.Google ScholarPubMed
McConnell, KJ, Ridgely, MS and McCarty, D (2012) What Oregon’s parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services. Drug and Alcohol Dependence 124, 340–346.CrossRefGoogle ScholarPubMed
Mental Health America (2008) What have states done to ensure insurance parity? http://takeaction.mentalhealthamerica.net/site/DocServer/Parity_Chart_2008_1_.pdf?docID=1161 [7 August 2018].Google Scholar
Mickus, M, Colenda, CC and Hogan, AJ (2000) Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatric Services 51(2): 199–202.CrossRefGoogle ScholarPubMed
National Association of Insurance Commissioners (NAIC) (2004–2014) Market share reports for the top 125 accident and health insurers by state and countrywide. Kansas City, Missouri.Google Scholar
National Conference of State Legislatures (2017) State insurance mandates and the ACA essential benefits provision, http://www.ncsl.org/research/health/state-ins-mandates-and-aca-essential-benefits.aspx [7 August 2018].Google Scholar
Oziransky, V, Jaksa, A and Janopaul-Naylor, E (2011) Parity from the consumer perspective: implications for federal implementation from New York’s parity evaluation. Psychiatric Services 62(4): 344–346.CrossRefGoogle ScholarPubMed
Pacheco, J (2012) The social contagion model: exploring the role of public opinion on the diffusion of antismoking legislation across the American states. Journal of Politics 74(1): 187–202.CrossRefGoogle Scholar
Pacula, RL and Sturm, R (2000) Mental health parity legislation: much ado about nothing? Health Services Research 35(1): 263–275.Google ScholarPubMed
Page, BI and Shapiro, RY (1983) Effects of public opinion on policy. American Political Science Review 77(1): 175–190.CrossRefGoogle Scholar
Quartana, PJ, Wilk, JE, Thomas, JL, Bray, RM, Rae Olmsted, KL, Brown, JM, Williams, J, Kim, PY, Clarke-Walper, K and Hoge, CW (2014) Trends in mental health services utilization and stigma in US soldiers from 2002 to 2011. American Journal of Public Health 104(9): 1671–1679.CrossRefGoogle ScholarPubMed
Reisinger Walker, E, Cummings, JR, Hockenberry, JM and Druss, BG (2015) Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatric Services 66(6): 578-584.CrossRefGoogle Scholar
Robinson, G, Connolly, J, Whitter, M and Magaña, C (2006) State Mandates for Treatment for Mental Illness and Substance Use Disorders (DHHS Pub. No. (SMA) 07-4228), Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.Google Scholar
Wen, H, Cummings, JR, Hockenberry, JM, Gaydos, LM and Druss, BG (2013) State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation. JAMA Psychiatry 70(12): 1355–1362.CrossRefGoogle ScholarPubMed