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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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