Looking ahead to the Affordable Care Act: How can it make America’s mental health system better?

June 30, 2013


by Michael Cahill


Last year, the tragedies in Aurora and Sandy Hook put America’s poor mental health system into the national spotlight. They revealed an expensive system devastated by budget cuts as a result of the 2008 – 2009 financial crisis. These cuts forced the closure and downsizing of state-run mental health facilities, driving up the cost of treatment.


The Substance Abuse and Mental Health Services Administration found that the cost of mental health treatment was the main obstacle for people when choosing to seek mental health care. The agency also discovered that the majority of those with health insurance actually have significant limitations on coverage when it comes to mental health services.


So if the primary barrier to mental health treatment for Americans is cost, that’s where the Affordable Care Act comes in. Here are five ways it can help improve our situation:

1. Mental health coverage included in every plan


The Affordable Care Act (ACA) will take full effect beginning next year. It brings with it a mandated list of “essential health benefits” in 10 categories that insurance companies must cover with each new plan they offer. This mandate will help provide some 32 million Americans get mental health coverage for the first time.


The ten categories issued by the federal government will have direct and indirect impact on mental health. However, three benefits stand out – mental health and substance use disorder services (includes behavioral health treatment), prescription drugs, as well as preventive and wellness services.


According to numbers from the White House, 20 percent of health insurance plans do not include mental health coverage and about a third do not cover substance abuse treatment.


Aside from providing 32 million Americans with access to mental health care for the first time, the ACA will also improve mental health coverage for the 30 million who already have it, said Health and Human Services Secretary Kathleen Sebelius.


2. Health plans will be more affordable


For years, health insurance companies were allowed to discriminate against customers and their beneficiaries based on their health status. Starting in 2014, customers cannot be denied coverage or charged extra because of a pre-existing condition.


Under the law, the lifetime and annual limits for spending on health benefits will also be removed. This means there can be no limit to how much your health insurer will pay to cover your mental health benefits. Likely this is welcome news for people with a mental illness who need more resources because of their condition.


Preventive and wellness programs are also mandated under Obamacare. People who suffer from mental illness are at high risk for chronic diseases such as diabetes, heart problems, and cancer. Health insurers are not allowed to charge co-pays, co-insurance, or deductibles for these measures.


Having a preventive care program is important for people with mental illness since almost 70 percent are likely to smoke. Smoking cessation counseling and aides are included in preventive programs starting next year.


3. You can buy coverage through the Health Insurance Exchanges


Health Insurance Exchanges will be new marketplaces where individuals and small businesses can compare and choose the right plan for them. Each state will have its own exchange and enrollment for plans will be available starting Oct. 1, 2013 for coverage starting on Jan. 1, 2014.


Those who suffer from mental health disorders can now easily access information about different plans and buy the one they prefer. Assistance via call centers will be available to help consumers make their choice. All plans sold in the exchanges will include the “essential health benefits.”


Customers can also find out if they qualify for the government subsidies available for low income families and individuals. Those who earn between 133 and 400 percent of the federal poverty level do not have to pay more than 9.5 percent of their yearly income for health coverage. The 9.5 percent is a sliding number, which means those who earn less will have more affordable plans.


4. Medicaid coverage will be expanded.


Many health advocates say that Medicaid expansion will improve access to mental health services.


According to a study by the National Alliance for Mental Illness (NAMI), the Medicaid expansion will help approximately 2.7 million uninsured individuals who currently suffer from mental illness nationwide.

Medicaid will provide health coverage for the poorest of the nation’s uninsured. Government subsidies will be 100 percent for the first 3 years and then at least 90 percent for the next 7 years. Those who earn up to 133 percent of the federal poverty level (around $15,000 annually for an individual) will be included in the expansion.


Unfortunately, the expansion will not be available across the country. So far, twenty states and the District of Columbia have signed on, while fourteen states have rejected it.


5. Quality and availability of services will be improved


Obamacare doesn’t stop at providing health insurance and increasing coverage. The law also focuses on improving the quality of services delivered by the health care system.


Treating mental illness is not only expensive, it is also very complex. What works for one patient may not work for the other. Going in and out of treatment is common among people with mental health disorders.


The new healthcare law will also create the National Strategy for Quality Improvement which focuses on the overall improvement of health care delivery. High-cost chronic diseases including mental illness will be a priority.


The Centers for Excellence in Depression will also be established to develop coordinated and integrated care, encourage positive health behaviors and outcomes, and promote interdisciplinary training of mental health professionals.


Author Bio: Michael Cahill is the editor of the Vista Health Solutions blog. Follow him on Twitter at @Vistahealth  and @Electronicmike