Affordable care act mental health care coverage – will it improve the treatment of mental health, and if so, how?
To help us understand the implications of the Affordable Care Act for mental health coverage, Michael Cahill, Editor of the Vista Health Solutions blog, provides the following guest post. Cahill has a degree in Journalism from SUNY New Paltz and previously worked as a reporter for the Poughkeepsie Journal and an editor for the Rockland County Times. You can follow him on Twitter at @VistaHealth and @ElectronicMike
How Will the Affordable Care Act Improve Mental Health Coverage by Michael Cahill
Mental health has been a long standing issue in America. Recently, we’ve seen a decrease in public spending for mental health first because of recession and now the sequestration. As a result, many state-run psychiatric hospitals were either downsized or closed. Mental health services for the poor and those in the criminal justice system were also victimized by the cutbacks.
In the wake of last year’s Sandy Hook and Aurora tragedies, we might finally see things turn around. We can no longer ignore the consequences of our failure to address mental health problems in our country. Several states are already taking steps to restore funding. President Barack Obama’s landmark Affordable Care Act (ACA) includes provisions to improve mental health coverage.
Whether we’ll see these improvements right away remains to be seen. During the White House’s National Conference on Mental Health, President Obama called for a more honest, open and understanding discussions about mental health and how it affects all of us.
“For many people who suffer from mental illness, recovery can be challenging,” Obama said. “What gives so many of our friends and loved ones strength is the knowledge that you’re not alone. You’re surrounded by people who care about you and will support you on the journey to get well. We’re here for you.”
Many people see that the ACA is on the right track toward achieving that goal. Here are some reasons why:
1. No denial because of “pre-existing” conditions
Approximately 20 percent of American adults suffer from a mental illness. For years, health insurance companies considered mental health disorders a form of a pre-existing condition. and Those with a history were usually denied coverage or charged more. Thanks to the ACA, that practice will soon be over.
Starting in 2014, health insurers can no longer discriminate against individual participants and their beneficiaries based on health status. So, even if you suffer from some sort of mental illness, you cannot be denied coverage or charged more for your health insurance.
Right now, individuals with health problems (including mental illness) can get coverage through high risk health insurance pools available in each state.
Critics claim that this will raise health insurance costs because more sick people will enter the marketplace. However, premium tax credits will be available to qualified individuals and families.
2. More people will have access to Medicaid
Medicaid expansion is a major component of the ACA and mental health advocates claim that this portion of the law will improve access to services. Budget cuts for mental health programs from 2009 to 2012 caused half of patients with mental illnesses like depression, schizophrenia, and bipolar disorder to go without treatment or medication because of lack health insurance and access to care.
According to a report by the National Alliance for Mental Illness, Medicaid expansion will help provide coverage to approximately 2.7 million uninsured individuals with mental illness nationwide. Treatment can help people with mental illness function normally, get back to work, and become self sufficient, the report said.
With Medicaid, the poorest of the uninsured will get coverage through a 100 percent federal government subsidy for the first three years and 90 percent or more for the next seven years. The expansion will include those who earn up to 133 percent of the federal poverty level; that’s about $15,000 annual income for an individual.
However, Medicaid expansion will not be available in every state. Right now, twenty states and the District of Columbia have committed to push through with the expansion, while fourteen have rejected the idea.
3. Mental health treatment is included with health insurance exchange plans
Starting Oct. 1, 2013, enrollment through the health insurance exchanges will begin. These are online marketplaces available in every state where people can compare plans and purchase the coverage that suits them.
Think of them as the Travelocity for health insurance plans. Through the exchanges, customers can find out if they qualify for government subsidy and assistance will be available via call centers.
Under the new healthcare law, all plans sold through the exchanges must cover the ten essential health benefits which includes mental health and substance use disorder services as well as prescription drugs. In addition, these services are required to be at the same level of coverage as medical/surgical services.
4. Premium tax credits for low income individuals
The ACA offers premium tax credits to low-income individuals and families to help them purchase health coverage on the exchanges.
If you or your family earns somewhere between 133 and 400 percent of the federal poverty level, the cost of your health plan cannot be more than 9.5 percent of your income. This is also a sliding number, which means your plans will cost less if you’re earning less.
Making plans more affordable is very important to promoting mental health. Several studies have shown a relationship exists, albeit a complex one, between poverty and mental illness. According to a report by the U.S. Substance Abuse and Mental Health Services Administration, 50 percent of Americans couldn’t afford the cost of their mental health treatment in 2011. That year, only 38 percent of the 45.6 million who suffered mental health problems received some form of mental health services.
5. No out of pocket costs for preventative care
People who suffer from serious mental illness have a greater risk for other health problems such as heart disease, cancer, and diabetes. The ACA addresses this problem by mandating that all new insurance plans must carry preventive care and medical screenings. These services must also be rated Level A or B by the U.S. Preventive Services Task Force. Health insurers cannot charge co-pays, co-insurance, or deductibles for these services.
An important issue for people with mental illness is smoking. Studies have shown that up to 70 percent of those with mental illness are more likely to smoke. Smoking is associated with a plethora of diseases that require even more access to health care. The preventive care provided by the ACA covers access to smoking cessation counseling and aides.
In the coming months, or even years, the debate on how we can improve our mental health coverage and services will likely continue. Experts from both sides will argue why their system works. While some of their points may be valid, we cannot ignore the fact that we need to take steps right now. The ACA may not be perfect, but it is a good start towards improving our country’s mental health.