The individual mandate, mental health parity, and the Obama Health Plan.

Barack Obama’s commitment to health reform began wellbefore his presidency. As candidate, he publicized a plan toincrease coverage for millions of Americans and lowercosts (Obama 2008a, b). As president, he signed into leg-islation the Patient Protection and Affordable Care Act(PPACA) in March 2010. President Obama may havesucceeded where previous presidents failed by learningfrom President Bill Clinton’s failures with health reform inthe 1990s, galvanizing Democrats politically, and tanta-lizing hospital, pharmaceutical, and insurance companieswith the prospect of expanded business from the newlyinsured (Oberlander 2010).PPACA has faced obstacles from the outset. Siding withRepublican presidential candidates and attorneys generalfrom 26 states who have vowed to repeal the bill (Cooper2011), the United States Court of Appeals for the EleventhCircuit found the bill unconstitutional, arguing that Con-gress exceeded powers to regulate interstate commerce bymandating purchase of health insurance (United StatesCourt of Appeals 2011). Federal judges in Florida (UnitedStates District Court for the Northern District of Florida2010) and Virginia (United States District Court for theEastern District of Virginia 2010) came to similar con-clusions. On November 14, 2011, the Supreme Courtagreed to hear challenges to PPACA, with oral argumentsscheduled for March 2012 and a possible decision reachedas soon as 3 months later, virtually insuring that PPACAbecomes an issue for the 2012 presidential elections(Liptak 2011). Fiscally conservative governors have alsothreatened to reject federal grants establishing state insur-ance exchanges, potentially limiting reform (Aggarwalet al. 2010).We believe that the movement to overturn PPACAwould not only impair progress toward universal healthcare in the U.S., but also threatens the parity of mentalhealth treatment on par with somatic illnesses. In the1970s, many states required health plans to specify mini-mum mental health beneﬁts such as number of inpatientand outpatient visits, though catastrophic coverage againstﬁnancial risk from severe illnesses was excluded and pri-vate plans outside state regulation were exempt (Franket al. 1997). In 1996, Senators Pete Domenici and PaulWellstone successfully sponsored the Mental Health ParityAct of 1996, requiring plans with ﬁfty or more employeesoffering mental health beneﬁts to apply the same lifetimeand annual dollar limits to mental health as for medical/surgical beneﬁts. Treatment of substance disorders and therequirement to provide mental health services, however,were excluded (Levinson and Druss 2000). In response toplans covering services only within network, increasingco-payments, and restricting services, the 2008 Paul Well-stone Mental Health and Addiction Equity Act mandatedcoverage of mental illness and substance abuse disorders onequal terms with other conditions. Businesses with less thanﬁfty employees and insurers exceeding speciﬁed costincreases based on claims data were exempted (Garcia2010). Throughout this time, sympathetic legislators havetried to dispel misconceptions that mental disorders areindeﬁnable, incurable, and expensive (Frank et al. 2001)or