Law intended to increase access to behavioral health care had little impact, study finds

September 8, 2018

A 2008 law that required insurance plans to offer mental health and addiction benefits at the same level as physical health benefits did not significantly reduce out-of-pocket spending on outpatient behavioral health services or increase their use, according to new research.

Alex Gertner

Alex Gertner

The study, “Effects of the Mental Health Parity and Addiction Equity Act on Specialty Outpatient Behavioral Health Spending and Utilization,” was authored by Alex K. Gertner, Jason Rotter and Gracelyn Cruden, all doctoral students in the Department of Health Policy and Management at the UNC-Chapel Hill Gillings School of Global Public Health.

The work was published Sept. 1 in The Journal of Mental Health Policy and Economics.

For decades, health plans charged higher out-of-pocket fees for behavioral health services compared to other medical services, and many of those plans had established quantitative treatment limits and administrative barriers specific to their behavioral health benefits.

In October 2008, President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), which required large health plans that include behavioral health benefits to offer them at parity with physical health benefits, starting in 2010.

“The most commonly reported reason for not using mental health services among people with mental health needs is the cost of care,” said Gertner, lead author on the paper. “The Mental Health Parity and Addiction Equity Act is the most far-reaching law on behavioral health coverage requirements for health plans. We know from previous research that MHPAEA led to improved behavioral health benefits, and many hoped the law would improve access to behavioral health services.”

The Gillings School team used national data to compare groups that likely were affected by the new law to groups that were not affected, in order to determine whether the law resulted in a greater number of outpatient visits to behavioral health providers or a lower financial burden for these visits.

According to their analysis, MHAPEA did not have such an impact. They found no substantial increases in use of outpatient specialty behavioral health care services or reductions in financial burden for these services on a national level.

The law may have had an effect in some states or for special groups, said Gertner, but the team measured only national trends. The team offered possible reasons why MHPAEA may not have improved access to care or eased financial burdens, including narrow insurance provider networks, stigma surrounding behavioral health and continued noncompliance with some of MHPAEA’s provisions.

“It is particularly difficult to enforce MHPAEA’s requirement that plans do not place stricter administrative burdens, such as prior authorization requirements, on behavioral health services,” Gertner said. “More research and policy are needed to improve access to behavioral health services, especially as deaths from overdoses and suicides continue to rise in the U.S.”


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Contact the Gillings School of Global Public Health communications team at sphcomm@listserv.unc.edu.

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