The Mental Health Parity Act: A Legislative History

Publication Date: January 2007

Publisher: Library of Congress. Congressional Research Service


Research Area: Health



This report provides a detailed history of mental health parity legislation, including a discussion of bills introduced in each Congress and any accompanying legislative action, including hearings, markups, and floor votes. The legislation is in response to concerns about the coverage of mental health benefits in group health plans, which is often more restricted than the coverage of physical illness.

Some advocates for people with mental illness strongly support legislation that would require full parity, citing research that has shown the cost-effectiveness of treating mental illnesses. On the other hand, health insurance plans and employers offering self-insured plans contend that parity legislation will lead to significant increases in the cost coverage.

Generally, the term full parity is used throughout the report to mean that the treatment limitations and financial requirements on mental health coverage are the same as those for coverage of physical illnesses. Treatment limitations include restrictions on the number of visits or days of coverage, or other limits on the duration and scope of treatment. Financial requirements include deductibles, coinsurance, copayments, and other cost-sharing requirements, as well as annual and lifetime dollar limits on coverage.

Mental health parity legislation was first introduced in 1992, and the Mental Health Parity Act (MHPA) of 1996 was the first federal parity law. MHPA required partial parity by mandating only that annual and lifetime dollar limits in coverage for mental health treatment under group health plans offering mental health coverage be no less than that for physical illnesses. It also provided an exemption to employers with fewer than 25 employees, and did not apply to employers offering self-insured plans. In 2001 and subsequent years, attempts to expand MHPA to require full parity have failed. In the meantime, MHPA continues to be extended on an annual basis. In contrast, about half of the states have passed laws requiring full parity for mental health coverage.