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
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  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.