Mental Healthcare Benefits Under the Affordable Care Act

With the imminent arrival of the already-much-loathed DSM 5 and my thoughts more frequently turning to moving back to the US (I currently live in The Netherlands), I’ve been thinking a lot about what a move would/will mean for my mental healthcare.

By the time I return, the Affordable Care Act (AKA ‘ObamaCare’) will have gone live.  I never paid much attention to the finer points.  I will probably never have to opt in, but would still like to be educated about the peaks and pitfalls. In the last

English: Barack Obama signing the Patient Prot...
Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

two weeks there has been a spate of articles on the topic in mental-health-related publications, so now is as good a time as any to get the skinny.   A lot of noise is (again) being made in the right-wing media on the subject.  Since the GOP BS Machine has been known to spout incorrect rhetoric, I wanted my own answers.

For starters, I went directly to The White House.  Well, the blog, anyway.  There I found an entry by Kathleen Sebelius, the US Secretary of Health and Human Services, that was cross-posted from the HHS (Health and Human Services) blog.  While the majority of the April 10, 2013 entry talks to gun violence prevention, there is a paragraph that addresses the Affordable Care Act and mental illness coverage:

The President’s [2014] budget builds on the historic advances we have made to close the gaps that left too many Americans with behavioral health problems uninsured and underinsured. Beginning in 2014, the Affordable Care Act will provide access to quality health care that includes coverage for mental health and substance use disorder services. All new small group and individual private market plans will be required to cover mental health and substance use disorder services as part of the health care law’s Essential Health Benefits categories, and behavioral health benefits will be covered at parity with medical and surgical benefits. Also in 2014, insurers will no longer be able to deny anyone coverage because of a pre-existing behavioral health condition. The Affordable Care Act has already ensured that new health plans cover recommended preventive benefits without cost sharing, including depression screening for adults and adolescents and behavioral assessments for children.

Underline is mine, and a point that had nagged at me.  Both the GOP and some psychiatric publications have stated that under the Affordable Care Act, mental healthcare would not be covered by the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).  They are wrong.  Thankfully.

As I continued to read, I delved further into more views of those in the crazy-biz.  Three themes kept emerging:

  • Under the Affordable Care Act, mental health benefits will differ state to state.
  • The American Psychiatric Association has already written a letter to The Department of Health and Human Services over concerns that states would judge network adequacy for psychiatrists included in QHP [qualified health plans] networks on the basis of the number of psychiatrists in a network, as opposed to the number of days it takes for a patient to get an appointment with a psychiatrist.”
  • If your doc prescribes a drug that is not in ‘the formulary,’ patients are certainly free to file an appeal (much the way most insurance companies demand today) so it will be covered. “The HHS declined to order formularies in QHPs to adhere to the Medicare Part D requirement that all drugs in 6 “protected” categories be available. Those 6 include antidepressants and antipsychotics.”

Combine the info from the first and third bullet points, and the sum is that one state may offer access to 250 ‘covered’ drugs while another could offer over 700.

It is worth noting that those three points above are being broadcast by a constituency that has a lot of skin in the game.   And, nothing above is surprising, really.  Typical red tape you’d expect to come across when dealing with any insurance plan.  So, it’s understandable why mental healthcare workers aren’t enchanted with these things.

To be fair, I did visit a few right-wing/I Hate ObamaCare news sites and blogs as well.  While I was looking for info specifically related to opinions on the Affordable Care Act as it pertains to mental illness coverage, there was a pervasive undercurrent of a lack of understanding of how the US Federal Government works in general.  I state this not for any partisan reason, but to call out that I am suspect of the information I was able to uncover.  Basically, the takeaway from those sites I visited is that expanded mental health coverage under the Affordable Care Act will put a serious strain on mental healthcare providers, due to the approximately 60 million new patients who will become eligible for mental health treatment.  The CEO of behavioral health services for the Henry Ford Health System stated that the influx of new patients from the health law would strain the nation’s mental health workforce. “We now worry that we [will] have the providers and the delivery system to take care of them,”  I could find no mention of how those opposed to the Affordable Care Act would remedy this particular problem.

Finally, I visited NAMI (National Alliance on Mental Illness).  They provide a very useful FAQ and downloads to help those with mental illness navigate the coming changes the Affordable Care Act will bring.  One item I am particularly happy to see is a Policy Maker’s Toolkit.  For the laypeople among us, it’s a small glimpse into the considerations that need to be made when making mental health policy decisions.

Bottom line:   I was expecting to find at least some controversial ‘stuff’ when researching this topic.  Truthfully, I found nothing I didn’t already expect.  The worst thing that I can see from the amount of research I had the time to do is the Affordable Care Act does not set a nationwide, uniform standard for determining what kind of coverage benefits each level should include. That decision will be left to the states, a point of concern to some healthcare-advocacy groups.  Quite frankly, it is a concern of mine as well.

In the end, let’s not forget this is a fledgeling program, and like the 787, it’s going to need to work out the kinks so it can truly fly.  From a personal perspective, I am happy 60+ million Americans will finally have access to mental healthcare.

It’s about time.

Thanks for doing all the leg work on this, Vivien. I’m particularly happy to see behavioral health will get parity with other med/surg coverage. That seems like a huge win.

Hi, Sandy! HUGE win, right? No, Affordable Care ain’t perfect, but I’m sure there are plenty of people out there who are glad they will have something.

Great write up here. I am skeptical of just how good the coverage will be in some states. I feel that lots of people will get denied any care for it will be next to impossible to find a MD that will take what ever coverage one is lucky enough to get. I’ve already been hearing all sorts of tales about folks whose insurance became so high that they could no longer afford insurance. This was supposedly as part of the Federal Insurance Pool.

The company that my daughter has closed its open season saying that “they” could no longer afford to take new patients with all “the perexisting conditions.” We feel lucky that she got in that pool before it was closed.

I fear the worst because MDs will do as they please. One can call up for an appointment and be denied as a new patient. MDs are in cahoots with insurance companies. Thus “we the people” are and will be screwed. glued and,tatooed. The US government can make all the laws it wants but the health care system is about making huge profits and the MDs and hospitals can skirt aound the laws.That is merely my personal opinion. I am a liberal and always have been. I am for helping the poor and people in need.

I truly hope you will be okay with health care when you get back to the states. I think you are a talented writer and know how to research a topic.

Hi! Thanks for the thoughtful reply. I’m also wondering how good the coverage is going to be in some states. Like I said, I may never have to opt in, but before we return I’ve got to do my homework so we can choose a ‘good’ state, just in case.

I’m happy to hear your daughter was able to get insurance! This preexisting condition stuff has always been such a bunch of BS. What really irks me is no one is addressing the real problem and going after the real villains – the insurance companies and big pharma. The God-Almighty Dollar certainly rules the healthcare industry.

I’m probably going to take flack for this from some of my readers, but everyone should keep in mind that I, too, am pretty liberal. It’s hard not to be when coping with a disease that puts you on the fringe, in a group that is marginalized. Right now, I receive my healthcare from a ‘socialist’ system. I couldn’t be happier or more complimentary to the Dutch system. In a report by Business Insider International last year, The Netherlands ranked 17th, the US 37th (and there were only 36 countries in the poll). My point is that when implemented correctly, in my experience, socialist healthcare works. Now, in the US ‘socialist’ is a dirty word, but people need to get over themselves. Heck, even the supposedly crummy NHS in the UK outranks the US. The Affordable Care Act isn’t perfect (I have a few serious reservations), but it’s a start. The healthcare in the US, especially the mental healthcare, is abysmal. Oh, unless you’re rich. Or famous. 🙂

Thanks again for the reply. Take care!

Havent seen that yet. Just reading emails from the state senate and my district representative stating that they plan to opt outand are not taking any gov money. I think this will be a huge fight in the next couple years between the gov trying to force states to accept it and the states who don’t resisting. I was wondering what all those rounds of bullets were for, I think I answered my own question….

I moved back to the USA a couple of years ago after living in the UK for nearly a decade. I have to say that I’m happy I returned. It was the right action to take to get me out of the depression I was in there (due to lifestyle changes, not lack of medical care). However… I do miss the healthcare system in the UK. It may not have provided the very best care, but I was never made to feel inadequate as I’ve been made to feel here. The USA still does not regard mental illness as a disease. If you’re able to use utensils and a toilet by yourself, then you are more than capable of affording outrageous healthcare plans. It’s been my greatest struggle since moving back. Just my thoughts on the matter.

Hi – thanks very much for replying! I completely understand how moving back to the US helped your depression. We are (were) in similar situations. I am not adjusting well to my adopted land and know it is a huge source of angst for me. What is so striking about your comment is that you talked about being treated in a more dignified manner than the US along with the quality of care you received in the UK. That’s it in a thimble, isn’t it? We are people. Who appreciate being treated as such.

Glad to hear you’re home again! Be well!

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