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The Growing Importance of Mental Health Parity

Published online by Cambridge University Press:  06 January 2021

Jessica A. Scarbrough
Jessica A. Scarbrough*
Affiliation:
Psychology and Political Science from the Pennsylvania State University and Boston University School of Law
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Extract

Mental health is currently one of the most expensive health care issues. The cost of treating mental illness’s effects not only impacts the health care industry as a whole, but also imposes indirect costs on businesses through absenteeism, lower productivity, and reduced earnings. Mental illness, and the effects of mental illness, costs the U.S. economy several billion dollars in losses every year, with predictions suggesting that these costs will only continue to rise in the next two decades. Between 2006 and 2009 alone the costs of mental health care rose from approximately $57 billion to more than $150 billion. These numbers will likely be exacerbated due to the mental health problems that are continuing to rise within the United States as teenagers and adolescents are experiencing mental illness at escalating rates. Despite the rapid growth of mental illness, mental health coverage has not been expanding to meet the increasing demand for treatment. It is estimated that about 28% of the U.S. population has a diagnosable mental illness, even though only 8% actually seek treatment.

Type
Notes & Recent Transaction Comments
Information
American Journal of Law & Medicine , Volume 44 , Issue 2-3: Symposium - The 21st Century Cures Act: A Cure for the 21st Century? , May 2018 , pp. 453 - 474
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2018

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References

1 See Lucy Larner, In 2013, US Spent More on Mental Disorders Than on Any Other Medical Condition, Health Aff. Blog (May 18, 2016), http://healthaffairs.org/blog/2016/05/18/health-affairs-web-first-in-2013-us-spent-more-on-mental-disorders-than-on-any-other-medical-condition/ [https://perma.cc/M4PQ-7PVP].

2 Sara Markowitz, Mental Health and Public Policy (2005) (Research Summary) (Nat'l Bureau of Econ. Research), http://www.nber.org/reporter/spring05/markowitz.html [https://perma.cc/TQP3-LWUS].

3 See Thomas Insel, Post by Former NIMH Director Thomas Insel: The Global Cost of Mental Illness, Nat'l Inst. Mental Health (September 28, 2011), https://www.nimh.nih.gov/about/director/2011/the-global-cost-of-mental-illness.shtml [https://perma.cc/W62J-MWC6].

4 Id.; see Katharine R. Levit et al., Federal Spending on Behavioral Health Accelerated During Recession as Individuals Lost Employer Insurance, 32(4) Health Aff. 952, 952-56 (2013), http://content.healthaffairs.org/content/32/5/952.abstract [https://perma.cc/6S8J-4UKX].

5 See Susanna Schrobsdorff, The Kids Are Not All Right, Time Magazine, Nov. 7, 2016, at 47.

6 Markowitz, supra note 2.

7 See Issue Brief: Parity, Mental Health America, http://www.mentalhealthamerica.net/issues/issue-brief-parity [https://perma.cc/EX5X-MSEL].

8 See generally Nelson, Keith, Legislative and Judicial Solutions for Mental Health Parity: S. 543, Reasonable Accommodation, and an Individualized Remedy Under Title I of the ADA, 51 Am. U. L. Rev. 91 (2001)Google Scholar (discussing how most plans impose higher costs on those utilizing mental health benefits); see generally also Barrett, Jeffrey M., A State of Disorder: An Analysis of Mental-Health Parity in Wisconsin and a Suggestion for Future Legislation, 2008 Wis. L. Rev. 1159 (2008)Google Scholar; see generally also Kessler, Suann, Mental Health Parity: The Patient Protection and Affordable Care Act and the Parity Definition Implications, 6 Hastings Sci. & Tech. L.J. 145 (2014)Google Scholar.

9 See Issue Brief: Parity, supra note 7.

10 See generally Barrett, supra note 8; see also Kessler, supra note 8.

11 Shamash, Aviv, A Piecemeal, Step-By-Step Approach Toward Mental Health Parity, 7 J. Health & Biomedical L. 273, 280-82 (2011)Google Scholar (discussing Congress's first attempt at mental health parity legislation).

12 Id.

13 Id.

14 See id. at 280-300.

15 Shamash, supra note 11, at 280-300.

16 Kaplan, Dana L., Can Legislation Alone Solve American's Mental Health Dilemma? Current State Legislative Schemes Cannot Achieve Mental Health Parity, 8 Quinnipiac Health L.J. 325, 329-332 (2005)Google Scholar.

17 Garcia, Richard A., Equity For All?, 31 J. Legal Med. 137, 142 (2010)CrossRefGoogle ScholarPubMed (discussing the introduction of the MHPAEA).

18 Shamash, supra note 11, at 284-85.

19 Id.; see also Garcia, supra note 17, at 142-43.

20 Shamash, supra note 11, at 286; Garcia, supra note 17, at 143.

21 Shamash, supra note 11, at 293.

22 Id.

23 See Noonan, Kathleen G. & Boraske, Stephen J., Enforcing Mental Health Parity Through the Affordable Care Act's Essential Health Benefit Mandate, 24 Annals Health L. 252, 252-56 (2015)Google Scholar (introducing the mental health requirements of the ACA); see also Shamash, supra note 11, at 296.

24 See Noonan, supra note 23, at 254-55; see also Shamash, supra note 11, at 296.

25 Shamash, supra note 11, at 293.

26 See id. at 294-309.

27 Policy Brief, Health Affairs, Health Policy Brief: Enforcing Mental Health (Nov. 13, 2015), http://healthaffairs.org/blog/2015/11/13/health-policy-brief-enforcing-mental-health-parity/ [https://perma.cc/X48G-95ND]; see also Shamash, supra note 11, at 286.

28 See Ana Radelat, Senate Approves Murphy Mental Health Bill, CT Mirror, Dec. 7, 2016, http://ctmirror.org/2016/12/07/senate-approves-murphy-mental-health-bill/ [https://perma.cc/5KWF-KAWG]; see also Liz Szabo, Metal Health Care Gets a Boost from 21st Century Cures Act, NPR (Dec. 7, 2016, 5:08 PM), http://www.npr.org/sections/health-shots/2016/12/07/504725936/mental-health-care-gets-a-boost-from-21st-century-cures-act [https://perma.cc/JHD5-ENTQ].

29 See Radelat, supra note 28; see also Szabo, supra note 28.

30 See Radelat, supra note 28; see also Szabo, supra note 28.

31 See generally Am. Psychiatric Ass'n v. Anthem Health Plans, Inc., 821 F.3d 352 (2d Cir. 2016); see also New York State Psychiatric Ass'n, Inc. v. UnitedHealth Group, 798 F.3d 125 (2d Cir. 2015); see also Wilson v. Anthem Health Plans of Kentucky, Inc., 2017 WL 56064 (W.D. Ky. 2017); see also Danny P. v. Catholic Health Initiatives, 2016 WL 3551972 (W.D. WA, 2016); see also Natalie V. v. Health Care Serv. Corp., 2016 U.S. Dist. LEXIS 123783 (N.D. Ill. 2016); see also Smith v. U.S. Office of Pers. Mgmt., 80 F. Supp.3d 575 (E.D. Penn. 2014); see also Coal. for Parity, Inc. v. Sebelius, 709 F. Supp. 2d 10 (D.D.C. 2010).

32 See generally Am. Psychiatric Ass'n, Inc., 821 F.3d 352; see also N.Y. State Psychiatric Ass'n, Inc., 798 F.3d 125; see also Wilson, 2017 WL 56064; see also Danny P., 2016 WL 3551972; see also Natalie V., 2016 U.S. Dist. LEXIS 123783; see also Smith, 80 F. Supp.3d 575; see also Coal. for Parity, Inc., 709 F. Supp.2d 10.

33 Maggie Haberman & Robert Pear, Trump Orders Swift Remake of Health Act, N.Y. Times, Jan. 11, 2017, https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-donald-trump.html?_r=0.

34 Reed Abelson, Trump Signals Shifting Views of Health Law, N.Y. Times, Nov. 12, 2016, https://www.nytimes.com/2016/11/12/business/insurers-unprepared-for-obamacare-repeal.html.

35 See Robert Pear, Without the Insurance Mandate, Health Care's Future May Be in Doubt, N.Y. Times, Dec. 19, 2017, at A19.

36 Shamash, supra note 11, at 279.

37 Id.

38 Id.

39 Id.

40 See id.

41 Robert Pear, Insurance Plans Skirt Requirement on Mental Health, N.Y. Times, Dec. 26, 1998, http://www.nytimes.com/1998/12/26/us/insurance-plans-skirt-requirement-on-mental-health.html.

42 Shamash, supra note 11, at 280. During the initial stages of working to pass and enact laws providing mental health parity, many were concerned about the cost of it. There were concerns that requiring parity would significantly increase the cost of health insurance for consumers and companies.

43 Id. at 281.

44 Id.

45 Id.

46 Id. at 282-84; see Kaplan, supra note 16, at 330-32.

47 See Kaplan, supra note 16, at 330-33.

48 See id.

49 See Shamash, supra note 11, at 280-83.

50 Jordan Burt LLP, New Law Breaks Ground on Mental Health Coverage, (Dec. 2008), Westlaw 16 No. 12 Conn. Emp. L. Letter 5.

51 Id.

52 Id.

53 Shamash, supra note 11, at 282.

54 Id.

55 Pear, supra note 41.

56 Robert Pear, Many Employers Found to Violate Law Requiring Parity for Mental Health Coverage, N.Y. Times, May 18, 2000, http://www.nytimes.com/2000/05/18/us/many-employers-found-to-violate-law-requiring-parity-for-mental-health-coverage.html.

57 Id.

58 Id.

59 Id.

60 Id.

61 Kaplan, supra note 17, at 344-46.

62 Id.

63 Id.

64 Id.

65 Id.

66 Issue Brief: Parity, supra note 9; Kaplan, supra note 17, at 345-46.

67 Jordan Burt LLP, supra note 50.

68 See Maureen Minehan, Mental Health Parity Becomes Reality, (Oct. 2008), Westlaw 25 No. 23 Emp. Alert 1.

69 Coal. for Parity, Inc., 709 F. Supp. 2d at *12-14.

70 Minehan, supra note 68.

71 See Policy Brief, supra note 27.

72 See Minehan, supra note 68.

73 Id.

74 Id.

75 Parity Implementation Coalition, https://parityispersonal.org/coalition [https://perma.cc/H9AQ-RX37].

76 See Burt LLP, supra note 50.

77 Id.

78 Shamash, supra note 11, at 284-87.

79 Minehan, supra note 68.

80 Id.

81 Id.

82 Shamash, supra note 11, at 286.

83 Policy Brief, supra note 27.

84 Id.

85 Shamash, supra note 11, at 287.

86 Id.

87 See id. at 287-8.

88 See id. at 288-9.

89 Id.

90 See id. at 288-92.

91 See id.

92 Id. at 291.

93 Id. at 286

94 Id.

95 Shamash, supra note 11, at 286.

96 Id.

97 Id. at 294.

98 Behbahani, Samantha M., The Patient Protection and Affordable Care Act: Will Parity for Mental Health Care Truly be Achieved in the 21 st Century?, 10 Intercultural Hum. Rts. L. Rev. 153, 160-61 (2015)Google Scholar.

99 Issue Brief: Parity, supra note 9.

100 Behbahani, supra note 98, at 165.

101 Id.

102 Id. at 161.

103 See id. at 161-62.

104 Id. at 166-69.

105 The Mental Health and Substance Use Disorder Parity Task Force, Final Report (2016), https://www.hhs.gov/sites/default/files/mental-health-substance-use-disorder-parity-task-force-final-report.pdf [https://perma.cc/7WKY-VSRA].

106 Shamash, supra note 11, at 297.

107 Id.

108 Behbahani, supra note 98, at 175-77.

109 Id.

110 Policy Brief, Health Affairs, supra note 27.

111 See Bruce Japsen, ‘60 Minutes’ Shows Insurers Deny Mental Health Treatment Despite ACA Rules, Forbes (Dec. 14, 2014 7:50 PM), https://www.forbes.com/sites/brucejapsen/2014/12/14/60-minutes-shows-mental-health-claim-denials-persist-despite-obamacare-rules/#42b32b4654c5 [https://perma.cc/3NLJ-CPWR].

112 See generally Am. Psychiatric Ass'n, Inc., 821 F.3d 352; see also N.Y State Psychiatric Ass'n, Inc., 798 F.3d 125; see also Wilson, 2017 WL 56064; see also Danny P., 2016 WL 3551972; see also Natalie V., 2016 U.S. Dist. LEXIS 123783; see also Smith, 80 F. Supp. 3d 575; see also Coal. for Parity, Inc., 709 F. Supp. 2d 10.

113 See Kimberly Leonard, Patients with Mental Illness No Better Off Under Obamacare, U.S. News (April 15, 2015, 12:01 AM), https://www.usnews.com/news/articles/2015/04/01/health-insurance-coverage-discrimination-mental-illness [https://perma.cc/2XPN-RQYA].

114 See Am. Psychiatric Ass'n, 821 F.3d at 359-62.

115 See id. at 358; see also Wilson, 2017 WL 56064 at *2.

116 Am. Psychiatric Ass'n, 821 F.3d at 359.

117 Id. at 360.

118 Id.

119 Id.

120 See generally Wilson, 2017 WL 56064.

121 See generally Coal. for Parity, Inc., 709 F. Supp.2d.

122 See id. at 17-19; see also Danny P., 2016 WL 3551972 at *2.

123 See Issue Brief: Parity, supra note 9.

124 See B.D. v. Blue Cross Blue Shield of Ga., 2018 U.S. Dist. LEXIS 16993, *4-9 (N.D. Utah Jan. 2018).

125 See Smith, 80 F. Supp. 3d at 582-834; see also Wilson, 2017 WL 56064 at *2.

126 See generally Maria Stewart v. Applied Materials, Inc., Welfare Plan, No. 3:15-cv-026320JST (N.D. C.A. filed Sept. 30, 2016).

127 See id. at 8-9.

128 See generally Alexandra Carr v. United Healthcare Services, Inc., No. 2:15-cv-1105 JLR, (W.D. Wash. filed Jan. 24, 2017).

129 See Alexandra Carr, No. 2:15-cv-1105 JLR at 4.

130 See id. at 4-5.

131 N.Y. State Psychiatric Ass'n, 798 F.3d at 134.

132 Id. at 133-34.

133 Id.

134 Nathaniel Counts et al., What's Confusing Us About Mental Health Parity, Health Aff. (Dec. 22, 2016), http://healthaffairs.org/blog/2016/12/22/whats-confusing-us-about-mental-health-parity/ [https://perma.cc/DC5E-ZC8D].

135 Id.

136 See generally Alexandra Carr, No. 2:15-cv-1105 JLR; see also Maria Stewart, No. 3:15-cv-026320JST.

137 See Natalie V., 2016 U.S. Dist. LEXIS 123783, at *21 (N.D. Ill. 2016); see also Danny P., 2016 U.S. Dist. LEXIS 85654 at *4-7.

138 See Natalie V., 2016 U.S. Dist. LEXIS 123783, at *25.

139 See id. at *25-26.

140 Compare generally id., with Danny P., 2016 U.S. Dist. LEXIS 85654.

141 Lloyd Sederer, Trump's Recipe for More Addiction, U.S. News, Feb. 14, 2017, http://www.usnews.com/opinion/policy-dose/articles/2017-02-14/the-opioid-epidemic-could-worsen-under-donald-trump [https://perma.cc/HX9Z-KCPS].

142 See Sederer, supra note 140; see also Rebekah Mintzer, Fed Step Up Audits of Mental Health Benefits Parity, Daily Report, Dec. 28, 2016, http://www.dailyreportonline.com/recent-news/id=1202775872068/Feds-Step-Up-Audits-of-Mental-Health-Benefits-Parity?mcode=1202616187678&curindex=134&slreturn=20170115193312 [https://perma.cc/Q63T-ETFY]; see also Mental Health and Substance Use Disorder Parity Task Force, U.S. Dep't of Health and Human Servs., Final Report (Oct. 2016).

143 See Sunrise Detox III, LLC v. Cigna Behavioral Health, Inc., No. 0:17-cv-60170-BB (S.D. Fla. filed Jan. 23, 2017).

144 See id. at 6.

145 See id. at 8.

146 N.Y. State Psychiatric Ass'n, 798 F.3d at133.

147 Id.

148 See id.

149 Radelat, supra note 28.

150 Id.

151 21st Century Cures Act, Pub. L. No. 114-255.

152 Szabo, supra note 28.

153 Telephone Interview with Caitlin Peruccio, Legislative Aide, Office of Senator Chris Murphy (Jan. 26, 2018).

154 Id.

155 Id.

156 Id.

157 Szabo, supra note 28.

158 Radelat, supra note 28.

159 Id.

160 Szabo, supra note 28.

161 Radelat, supra note 28.

162 Szabo, supra note 28.

163 Id.

164 Id.

165 Radelat, supra note 28.

166 See id.

167 Szabo, supra note 28.

168 Radelat, supra note 28.

169 Id.

170 Id.

171 Szabo, supra note 28.

172 Id.

173 See Kelsey Snell, Spending Bill Caught in Partisan Fight Ahead of Friday Deadline, NPR (Mar. 20, 2018 12:46 PM), https://www.npr.org/2018/03/20/595197537/spending-bill-caught-in-partisan-fight-ahead-of-friday-deadline [https://perma.cc/QKS9-3KYW]; see also Richard Cowan, Congress Struggles to Meet Deadline for Government Funding Bill, Reuters (Mar. 19, 2018 8:28 PM), https://www.reuters.com/article/us-usa-fiscal-congress/congress-struggles-to-meet-deadline-for-government-funding-bill-idUSKBN1GW028 [https://perma.cc/386U-XDTK].

174 Szabo, supra note 28.

175 See id.

176 Id.

177 Id.

178 Dena Feldman, Twenty-First Century Cures Act Includes HIPAA Provisions, Covington Digital Health (Dec. 23, 2016), https://www.covingtondigitalhealth.com/2016/12/twenty-first-century-cures-act-includes-hipaa-provisions/ [https://perma.cc/4M6R-SLXQ]. The main thrust of the Cures Act initiatives relating to the Health Insurance Portability and Accountability Act have been to direct the Department of Health and Human Services to study whether and what regulations should be revised or clarified.

179 Szabo, supra note 28. Many mental health providers fear violating the Health Insurance Portability and Accountability Act even though experts say that that idea is just one of a number of serious misconceptions that exist relating to privacy laws and mental health information.

180 Id.

181 Healthcare Reform, Trump Pence: Make America Great Again, https://www.donaldjtrump.com/positions/healthcare-reform [https://web.archive.org/web/20170113154338/https://assets.donaldjtrump.com/HCReformPaper.pdf].

182 Id.

183 Id.

184 President Donald Trump: The White House Interview (ABC television broadcast Jan. 25, 2017).

185 Id.

186 Id.

187 Reed Abelson, Donald Trump Says He May Keep Parts of Obama Health Care Act, N.Y. Times, Nov. 11, 2016, http://www.nytimes.com/2016/11/12/business/insurers-unprepared-for-obamacare-repeal.html?_r=0.

188 See Scott Horsley, President Trump Vows to ‘Liberate’ U.S. From Opioid Crisis, NPR (Mar. 19, 2018), https://www.npr.org/2018/03/19/594999711/president-trump-vows-to-liberate-u-s-from-opioid-crisis [https://perma.cc/3Q2V-UXV4].

189 Id.

190 See Carl Hulse, ‘Repeal and Replace’: Words Still Hanging Over G.O.P's Health Care Strategy, N.Y. Times, Jan. 15, 2017, https://www.nytimes.com/2017/01/15/us/politics/affordable-care-act-republicans-health-care.html; see also Maggie Haberman & Robert Pear, Trump Tells Congress to Repeal and Replace Health Care Law ‘Very Quickly’, N.Y. Times, Jan. 10, 2017, https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-donald-trump.html.

191 See Ian Spatz & Michael Kolber, The Future of Essential Health Benefits, Health Aff. Blog (Feb. 14, 2017) http://healthaffairs.org/blog/2017/02/14/the-future-of-essential-health-benefits/ [https://perma.cc/GG84-3P37]; see also Michelle Chen, Trump's Obamacare Repeal Could Lead to a Mental-Health Crisis, Nation (Jan. 18, 2017), https://www.thenation.com/article/trumps-obamacare-repeal-could-lead-to-a-mental-health-crisis/ [https://perma.cc/SK84-6LKD].

192 Burgess Everett, Senate GOP Tries One Last Time to Repeal Obamacare, Politico (Sept. 17, 2017), https://www.politico.com/story/2017/09/17/obamacare-senate-republicans-repeal-242821 [https://perma.cc/L9KF-Z7B9]; Chris Riotta, GOP Aims to Kill Obamacare Yet Again After Failing 70 Times, Newsweek, July 29, 2017, http://www.newsweek.com/gop-health-care-bill-repeal-and-replace-70-failed-attempts-643832 [https://perma.cc/NYU2-V3YK]; Rachel Roubein, TIMELINE: The GOP's Failed Effort to Repeal ObamaCare, The Hill (Sept. 26, 2017), http://thehill.com/policy/healthcare/other/352587-timeline-the-gop-effort-to-repeal-and-replace-obamacare [https://perma.cc/93VT-BDJ3].

193 Timothy Jost, Examining the House Republican ACA Repeal and Replace Legislation, Health Aff. Blog (Mar. 7, 2017), http://healthaffairs.org/blog/2017/03/07/examining-the-house-republican-aca-repeal-and-replace-legislation/ [https://perma.cc/U23J-85SA].

194 See id.

195 See Burgess Everett & Jennifer Haberkorn, Trump's Obamacare Repeal Concessions Likely Can't Pass Senate, Politico (Mar. 23, 2017 1:54 PM), http://www.politico.com/story/2017/03/obamacare-repeal-votes-senate-236417 [https://perma.cc/8DZ8-22UY].

196 See generally Jost, supra 193; see also D'Angelo Gore et al., Q&A: The Facts on the Republican Health Care Bill, USA Today (Mar. 8, 2017 5:28 PM), http://www.usatoday.com/story/news/politics/2017/03/08/republican-health-care-bill-facts/98917660/ [https://perma.cc/S4DX-UFBN]; see also Katie Zezima & Christopher Ingraham, GOP Health-Care Bill Would Drop Addiction Treatment Mandate Covering 1.3 Million Americans, The Washington Post, Mar. 9, 2017, https://www.washingtonpost.com/news/wonk/wp/2017/03/09/gop-health-care-bill-would-drop-mental-health-coverage-mandate-covering-1-3-million-americans/?utm_term=.fb125408e477; see also Maggie Fox, Mental Health Groups Worry New GOP Plan Will Devastate Coverage, NBC News (Mar. 15, 2017), http://www.nbcnews.com/health/health-care/mental-health-groups-worry-new-gop-plan-will-devastate-coverage-n733601 [https://perma.cc/82WX-2B45]; see also Press Release, Am. Psychological Ass'n, APA Voices Concerns with American Health Care Act (Mar. 9, 2017), http://www.apa.org/news/press/releases/2017/03/health-care-act.aspx [https://perma.cc/ZK43-5RCE].

197 Jost, supra note 193; Gore et al., supra note 196.

198 Jost, supra note 193.

199 Id.; Gore et al., supra note 196.

200 Zezima & Ingraham, supra note 196.

201 Fox, supra note 196.

202 Zezima & Ingraham, supra note 196.

203 Id.

204 Id.

205 Fox, supra note 196.

206 See Zezima & Ingraham, supra note 196 (claiming lower income families tend to have higher incidences of mental illness and substance abuse).

207 See id.; see also Fox, supra note 196.

208 See id.

209 See id.

210 Id.

211 Id.

212 Press Release, supra note 196.

213 Id.

214 Id.

215 Stephen Collinson et al., House Republicans Pull Health Care Bill, CNN (Mar. 25, 2017), http://www.cnn.com/2017/03/24/politics/house-health-care-vote/index.html [https://perma.cc/2G4M-QWTU]; Phillip Elliott, 9 Strategic Mistakes President Trump and Republicans Made on Health Care, Time (Mar. 24, 2017), http://time.com/4712590/ahca-donald-trump-republicans-mistakes/ [https://perma.cc/RVA4-Y8Y2]; Robert Pear et al., G.O.P. Revolt Sinks Bid to Void Health Law, N.Y. Times, Mar. 25, 2017, at A1.

216 See Everett, supra note 192; see also Riotta, supra note 192; see also Roubein, supra note 192.

217 Emily Guskin & Scott Clement, Republicans' Obamacare Repeal Was Never Really That Popular, The Washington Post, July 28, 2017, at https://www.washingtonpost.com/news/the-fix/wp/2017/07/28/republicans-obamacare-repeal-was-never-really-that-popular/?utm_term=.cc39f9bf2456; Andy Slavitt, Republicans Didn't Repeal Obamacare. They Solidified it., The Washington Post (Dec. 22, 2017), https://www.washingtonpost.com/opinions/republicans-didnt-repeal-obamacare-they-solidified-it/2017/12/22/c2eec7e2-e72d-11e7-a65d-1ac0fd7f097e_story.html?utm_term=.25178a05cb05.

218 See Steven Shepard, Poll: Voters Oppose Straight Obamacare Repeal, Politico (July 25, 2017), https://www.politico.com/story/2017/07/25/poll-obamacare-repeal-no-replace-240937 [https://perma.cc/BH56-SRF7].

219 See Robert Pear, Without the Insurance Mandate, Health Care's Future May Be in Doubt, N.Y. Times, Dec. 19, 2017, at A19.

220 Id.

221 See id.

222 Amy Goldstein, Kentucky Becomes the First State Allowed to Impose Medicaid Work Requirement, The Washington Post (Jan. 12, 2017), https://www.washingtonpost.com/national/health-science/kentucky-becomes-the-first-state-allowed-to-impose-medicaid-work-requirement/2018/01/12/b7b56e3e-f7b4-11e7-b34a-b85626af34ef_story.html?utm_term=.ca5fb6222358 [https://perma.cc/D8TA-6GZQ]; Rachana Pradhan, Trump Administration Oks Medicaid Rollback in Kentucky, Politico (Jan. 12, 2017), https://www.politico.com/story/2018/01/12/trump-medicaid-work-requirement-kentucky-164638 [https://perma.cc/W6FR-CU9W].

223 Goldstein, supra note 222.

224 Pradhan, supra note 222

225 Markowitz, supra note 2.

226 Id.

227 Id.

228 Id.

229 Radelat, supra note 29.

230 Issue Brief: Parity, supra note 7.

231 21 st Century Cures Act Report Recommends Changes to Mental Health Care Infrastructure, Nat'l Alliance on Mental Illness Ga. (last visited Jan. 12, 2017), https://namiga.org/21st-century-cures-act-report-recommends-changes-mental-health-infrastructure/ [https://perma.cc/2665-L4A6]. This is also exacerbated by the decline in the amount of mental health facilities able to take on patients. See Samantha Raphelson, How the Loss of U.S. Psychiatric Hospitals Led to a Mental Health Crisis, NPR (Nov. 30, 2017), https://www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis [https://perma.cc/W8KS-MLHU].

232 Id.

233 Interdepartmental Serious Mental Illness Coordinating Committee, The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, 15 (Dec. 13, 2017), https://store.samhsa.gov/shin/content/PEP17-ISMICC-RTC/PEP17-ISMICC-RTC.pdf [https://perma.cc/ENS5-VAVS].

234 Id. at 45.

235 Id. at 15-16; Second Analysis of Insurance Data Confirms Lack of Access to Mental Health and Addiction Treatment for Millions of Americans, Parity Implementation Coalition (Dec. 21, 2017), https://parityispersonal.org/news/2017/second-analysis-of-insurance-data-confirms-lack-of-access-to-mental-health-and-addiction-treatment-for-millions-of-americans [https://perma.cc/SAH4-63MG].

236 Second Analysis of Insurance Data, supra note 235.

237 Id.

238 Brianna Ehley, Obamacare and Mental Health: An Unfinished Story, Politico (July 13, 2016), https://www.politico.com/story/2016/07/obamacare-mental-health-225445#ixzz4EIezqVJK [https://perma.cc/P3FE-CPJR].

239 Lagreca, Megan, Treating A Chronic Case of Discrimination: The Ninth Circuit's Prescription for Mental Health Patients' Rights in Harlick v. Blue Shield, 58 Vill. L. Rev. 269, 279-81 (2013)Google Scholar.

240 Id.

241 Lagreca, supra note 230.

242 Jim Greenwood, Celebrating 21st Century Cures One Year Later, BIOtechNow (Dec. 13, 2017), http:/http://www.biotech-now.org/health/2017/12/celebrating-21st-century-cures-one-year-later [https://perma.cc/HKG7-NVE5]; Tannaz Rasouli & Joseph Banez, NIH and FDA Leaders Update House Committee on 21st Century Cures Act Implementation, Ass'n of Amer. Med. C. (Dec. 1, 2017), https://www.aamc.org/advocacy/washhigh/highlights2017/485052/120117nihandfdaleadersupdatehousecommitteeon21stcenturycuresacti.html [https://perma.cc/97GR-CYJZ]; Tannaz Rasouli & Joseph Banez, Senate HELP Committee Holds Hearings on 21st Century Cures Act Implementation, Ass'n of Amer. Med. C. (Dec. 15, 2017), https://www.aamc.org/advocacy/washhigh/highlights2017/485342/121517senatehelpcommitteeholdshearingson21stcenturycuresactimple.html [https://perma.cc/3GKK-7MTK].

243 Press Release, Congressman Joe Kennedy III, Kennedy, Warren Intro Bill to Strengthen Mental Health Parity Laws (Jan. 11, 2017), https://kennedy.house.gov/media/press-releases/kennedy-warren-intro-bill-to-strengthen-mental-health-parity-laws [https://perma.cc/YW2B-Q6UQ].

244 The Mental Health and Substance Use Disorder Parity Task Force, supra note 107; Analysis Uncovers Significant Inequalities Between Mental and Physical Health: Lower Payments to Providers and Wide Disparities in Access to Benefits, Parity Implementation Coalition (Nov. 30, 2017), https://parityispersonal.org/news/2017/analysis-uncovers-significant-inequalities-between-mental-and-physical-health-lower-payments-to-providers-and-wide-disparities-in-access-to-benefits [https://perma.cc/5YK9-N4KM]; Second Analysis of Insurance Data, supra note 235.

245 U.S. Dep't of Health and Human Servs., Legal Action Center, Opinion Letter by Ellen M. Weber (July 26, 2017), https://www.hhs.gov/programs/topic-sites/mental-health-parity/achieving-parity/cures-act-parity-listening-session/comments/patients-and-advocates/legal-action-center/index.html [https://perma.cc/XF5U-7Z8Q].