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A Nonstarter: Repealing Mental Health Reforms Granted by Obamacare

By: Caren Howard, Advocacy Manager

One in five people in their lifetime will experience a mental health condition and four in 20 people will experience chronic, ongoing issues. Mental health is integral to overall health of an individual throughout their lifespan.

The Affordable Care Act (ACA) or “Obamacare” helped people in need of mental health and substance use disorder (MH/SUD) treatment because it no longer permitted insurance companies to exclude MH/SUD treatment from benefits. Companies now have to provide insurance plans that cover annual doctor’s visits and other preventive benefits that save money and lives like screening at no extra cost to the consumer.

The law incorporated evidence into policy: any health condition is best addressed when treated early on, before stage four (B4Stage4). And, the ACA extended MH/SUD parity into more types of insurance plans so beneficiaries would no longer be forced to pay more for MH/SUD treatment than they would for other types of medical and surgical benefits.

Obamacare also expanded eligibility criteria for Medicaid and greatly increased funding to states to cover low income adults in a ‘Medicaid expansion’ population. This may not mean much to you if you have employer sponsored health care, but if an employed family member or loved one does not have a health plan through an employer and their income is below 138% of the poverty level, this is a big deal. 

Nearly one in three Medicaid dollars is spent on MH/SUD services which helps catch conditions early, and when on-going treatment is required, helps to maintain employment, housing, and quality of life.  Many states under the ACA have moved toward more integrated, patient-centered care through creative and innovate delivery models. This means that providers may treat together conditions that occur together. Simple, right?

Obamacare allows young people, regardless of student or work status, to stay on their parent’s insurance until 26 years old – an age by which most mental health and substance use conditions will initially appear. To me, this was an important provision that hit home.

In high school, I visited the 9th grade guidance counselor to talk about anxiety that I experienced just before basketball tryouts began, and while it was nice for him to listen it was obvious he had little advice to offer. Several times throughout adolescence, my father and I had conversations about how anxious and moody I felt around the fall season and occasionally other times too. Infrequently, I attended grief therapy session to help me deal with the death of my mother at a young age, but it never occurred to me to talk about my feelings of anxiousness in that context.

When I was in college, I shared my “nervous” feelings with a trusted church member who happened to work in health care. She immediately encouraged me to seek treatment, saying “trying it out wouldn’t hurt.” And, nearly eight years after my first feelings of unknown butterflies, a psychiatrist offered a diagnosis. For me, the cost of waiting so long was dropping a full engineering scholarship and my varsity volleyball commitment as they had become too difficult to manage.

But, at 20 years old, I finally felt relief knowing there was a name for my feelings. Phew.

Looking back, I know that if I didn’t have health insurance through my school or my parent and I had to purchase it on my own, as many young people were unable to do before the ACA (indeed, this was the start of the Great Recession when jobs were slowing) I may not have seen a doctor for even more years and perhaps I wouldn’t be where I am today.

Right now Congress is debating the American Health Care Act (AHCA), a bill that puts all of the recent gains of mental health reform under Obamacare at stake. The Congressional Budget Office estimates that more than 24 million Americans will lose health insurance under the AHCA in ten years. Repealing the ACA will surely do greater harm by:

-          slashing funding for the Medicaid program, the largest financer of MH/SUD

-          discouraging healthy people from purchasing insurance until they need it by eliminating the penalty for not purchasing insurance

-          repealing the ACA’s basic benefits package which includes MH/SUD treatment.

It is a critical time for the future of health care and mental health systems and Americans must weigh in now – while Congress considers the ACA replacement bill. The House vote is scheduled on Thursday, March 24th and the following week the Senate is slated to take up the bill.

Sharing a personal story helps our elected representatives realize the impact of proposed policies beyond numbers and projections. You can call, write, post or tweet

Do as I just did, share your story with Congress and your Governors NOW, and, encourage loved ones to do the same. 

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