between 1992 and 2007 in total treatment
admissions compared to states with weak parity
laws (in which parity laws were absent or did
not include addiction treatment services). In
comparison, in states with limited parity laws (in
which parity was mandated but with limitations
such as applying to certain groups or a limited
number of health plans), there was only a 4.7
percent increase (compared to states with weak
parity laws) in addiction treatment admissions
during this time.^92
Among adolescents who received both an
addiction and psychiatric diagnosis, those living
in a state with a parity law expanding coverage
for addiction treatment are 4.5 times as likely to
be diagnosed with addiction and 3.2 times as
likely to receive treatment as adolescents in
states without such parity laws.^93
The Patient Protection and Affordable Care Act of 2010 ..........................................
The Patient Protection and Affordable Care Act
(ACA) of 2010 was enacted to expand access to
insurance for the uninsured, to make health care
more affordable and to reform health care
delivery systems to improve quality.^94 The
federal government estimates that the ACA
could expand coverage for addiction treatment
to an additional 4.8 million Americans if
coverage is offered at parity with other health
benefits.* 95
The ACA has the potential for increasing access
to addiction-related services by (1) increasing
the number of people who are covered by health
insurance^96 and (2) requiring that addiction
treatment benefits be offered by certain† health
- This estimate was for those who buy coverage in the
individual market, and while these plans must
provide some form of addiction treatment as part of
Essential Health Benefits, states have not yet defined
their Essential Health Benefits. It is unclear how
many states will include the full range of necessary
services for addiction treatment in their definition.
† Including new small fully-insured or self-insured
plans, new individual market health plans, qualified
health plans (as defined by the ACA), Basic Health
Programs and Medicaid benchmark/equivalent plans.
plans as part of an “essential health benefit”
package.^97 The ACA also extends requirements
of MHPAEA to some health plans to which the
law did not previously apply.‡ 98One main goal of the ACA is to increase the
number of people who have health insurance by
making more people eligible for Medicaid,^99
allowing individuals who do not have insurance
through their job to obtain insurance in state
exchanges (transparent and competitive
marketplaces), offering them income-based tax
credits and subsidies^100 and allowing young
adults under age 26 to remain covered by their
parents’ insurance plan.§ 101The ACA also attempts to change the way health
care is delivered to improve quality and integrate
addiction treatment into medical care, for
example through demonstration projects like
Medicaid health homes, where teams of health
professionals care for individuals with chronic
conditions including addiction;^102 accountable
care organizations (ACOs), in which groups of
health professionals coordinate services for
Medicare fee-for-service patients;^103 and through
temporary funding to expand the role of
community health centers.^104 If these initiatives
are successful and become common practice,
they will help to integrate the treatment of
addiction into mainstream medical practice and
expand the use of pharmaceutical therapies.^105‡ The ACA requires that qualified health plans
offered through the exchanges, individual (non-
group) market plans and Medicaid non-managed care
benchmark and benchmark-equivalent plans comply
with MHPAEA.
§ Even if they are married, in school or eligible to
enroll in their employer’s plan. Plans that existed on
March 23, 2010 do not have to offer dependent
coverage until 2014 if the dependent is eligible for
employer-sponsored insurance.