Mental Health, Substance Abuse Treatments to Get Big Boost Under Obamacare

About 20 percent of American adults will suffer from some type of mental health problem during any given year, and about 25 percent of this group will be stricken with a disorder serious enough to cause significant hardship for themselves and their families. But despite the disturbing prevalence of mental illness in this country, private health insurance coverage for mental health treatment services has been woefully lacking.Many health insurance plans offer some coverage for mental illness, but it is often quite restricted and will pay only for levels of care that are far too sparse to make a meaningful difference.

In order to be effective, mental health care must be flexible and open-ended, and insurance plans that place time limits on therapy sessions, hospital stays and other services rendered that are the equivalent of just a few hours per month offer little aid or comfort to patients suffering from life-altering emotional, behavioral or psychological disorders.

Less than 50 percent of those who are in need of mental health treatment are coming forward to request it (including only 60 percent of those with the most serious disorders) and there is little doubt that inadequate health insurance is one of the primary factors behind this disturbing statistic. However, thanks to the new Affordable Care Act (aka “Obamacare”) that will go into effect Jan. 1, this situation could soon change dramatically. The new health care law is designed to make quality private health insurance accessible to every American, regardless of income or previous medical history, and one of the ways it will try to improve things is by radically expanding coverage for mental health care and substance abuse treatment.

Insurance plans sold over the new government-sponsored health care exchanges will be required to provide extensive coverage for mental health and substance-use disorder treatment and screening (preventive) services. To help quantify these standards, the Affordable Care Act will mandate parity on the treatment side for physical and mental health disorders, meaning that the coverage offered for mental health services must match what is offered to people suffering from physical ailments or diseases.

Because the ACA does not establish baseline standards that all insurance plans must meet, some fear that health exchange providers may attempt to achieve parity by rationing care for physical conditions rather than expand mental health coverage. But since the new state health care exchanges will be organized as competitive marketplaces, giving consumers a broad range of options from which to choose, participating providers who try to skirt the rules in this manner would hardly seem likely to find success.

Some estimate that as many as 60 million Americans will gain access to new and/or improved mental health insurance coverage as a result of Obamacare. This number includes 30 million of the formerly uninsured and another 30 million who will be able to secure more extended mental health coverage than they had in the past. Of course parity for physical and mental health disorders will not automatically guarantee everyone immediate and unlimited access to comprehensive mental health care insurance, since economic circumstances will still force many consumers shopping on the exchanges to purchase less-than-perfect plans with high deductibles and prescribed limits on treatment for all disorders. But once the ACA goes into effect, the cumulative amount of health insurance available for Americans suffering from mental health and substance use disorders will skyrocket—and even those who do not choose to purchase government-regulated insurance plans could end up benefitting from the parity principle in the long run if it spurs an evolutionary change in the business practices of the insurance industry as a whole.

Dark Clouds on the Horizon

The Affordable Care Act could represent a major turning point and a gigantic step forward in the ongoing battle against the plague of mental illness, while also significantly expanding the available options for people struggling to overcome substance abuse. But the health insurance industry has profited enormously from the existing dysfunctional system and has been using its wealth and political connections to encourage and covertly fund the ongoing partisan guerilla warfare that is being waged in the media and on the floors of Congress against the supposed scourge of Obamacare. The opposition to the ACA is seeking to undermine the new law by any means necessary, using subterfuge, sabotage and dishonesty to manipulate public opinion and thwart the workings of our democratic system. These may seem like strong accusations, but they are entirely justified given the persistence of the current campaign to defund Obamacare despite the fact that it was enacted legally and fairly.

Of course, even many political progressives have also been critical of Obamacare, claiming that it will ultimately work against the public interest by strengthening a system that needs to be scrapped instead of reformed. They argue that comprehensive health care should be seen as a right rather than a privilege, and they believe that without a true public option, the majority of the population will continue to be overcharged and underprotected by a privatized system that routinely puts profits before people.

It is true that guaranteed universal health coverage for all would be the best alternative. But we are not living in an ideal world here, and from a strictly pragmatic standpoint, the Affordable Care Act is probably the best anyone could hope for at this historical juncture. And whatever its limitations might be, there is no question that Obamacare has the potential to be a godsend for millions of people who suffer from mental health conditions that need to be treated, and for all of those who will develop these disorders in the years ahead. No matter how the debate is spun, the movement toward parity in private health insurance should only be seen as a good thing, and the ACA’s efforts to bring about this important change are reason enough to hope that the current efforts to derail the new law eventually crash and burn.

Posted on October 11th, 2013
Posted in Mental Health

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