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With passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), the table has been set for sweeping changes in the way our nation understands, delivers, and pays for mental health care. As an author and co-sponsor of the parity law, I believe it offers vast opportunity to people who have arbitrarily been denied care for their disorders since as far back as we can remember. Because we were able to pass the parity law when we did in 2008, it established a floor for coverage in the Affordable Care Act that came along a year and a half later. Together, MHPAEA and ACA represent the greatest advance in several generations for insurance coverage and treatment of mental health disorders. But if we are realists, we must acknowledge that for the law to make the difference my co-sponsors and I hoped for, it must be implemented with vigilance and unwavering purpose. Writing the law was not enough; compliance with it must be monitored and enforced. And, meanwhile, practitioners, payers, employers, and educators must all examine and change their practices if the law is to fulfill its potential. None of us can wait for someone else to step forward; the responsibility for making parity real rests with each of us.
The articles in this Special Issue outline some of the risks and dangers that remain unaddressed by mere passage of these forward-looking laws as well as some of the pressures that the laws, in fact, create. We see from the outset that complacency is not an option. With insurers inclined to keep their reimbursements low, patients, practitioners, and advocates must develop and follow strategies, including further legislation, to secure the gains promised by parity and health reform.