The Politics And Economics Of Mental Health ‘Parity’ Laws

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Abstract
Prologue: “Politics is the art of the possible,” Otto von Bismarck once said. In the political saga described here, the “possible” turned out to be an amendment (Domeneci-Wellstone), originally intended to mandate full parity between mental health and medical/surgical benefits, that mandates instead only partial parity (“the same annual and lifetime limits on plan spending”). In addition, the amendment became part of a totally nonhealth-related appropriations bill instead of its original target, the Kassebaum-Kennedy bill. An irony of this “historic victory,” says lead author Richard Frank, is that the final amendment regulates “a market that isn't there anymore.” In this paper Frank and his colleagues Chris Koyanagi and Tom McGuire describe the economic forces that traditionally limited coverage of mental health care, the tortuous journey of the new parity amendment, and the challenges of ensuring access to mental health care in today's managed care world. Frank is a professor in the Department of Health...