With the Supreme Court ruling that the Patient Protection and Affordable Care Act — enacted by Congress in 2010 — can stand, it paves the way for full implementation of the law in the years to come.
There are many benefits to the law. For instance, eventually an insurer won’t be able to turn you down for a pre-existing psychiatric or health condition (kids are already covered by this provision; adults soon will be). Low-income people will also have greater access to an expanded version of Medicaid, the federal/state program for the poor and disabled.
Opponents of the law suggest it will drive up health-care costs — something the law wasn’t intended to fully address. Health care costs are already rising much faster than inflation, so this is an ongoing problem that most economists, politicians and physicians can find little agreement on how to solve. The Affordable Care Act is meant as a first step in controlling costs, however, by emphasizing preventative care and cooperative, integrated physician/hospital practices.
What does the Supreme Court ruling mean for access to mental health treatment and care in the years to come?
Nobody can predict with certainty the fallout in the years to come from the full implementation of the Affordable Care Act. But here are some of our predictions:
- Mental health care will become more accessible to more people.
With the passage of the federal mental health parity law a few years ago, many (but not all) insurers were required to treat mental disorders with the same coverage limits as any other disease or health concern. While this has helped many people obtain needed treatment without having to jump through as many insurance company hoops, it hasn’t really mattered much to the poor — who didn’t have insurance coverage in the first place.
With more people obtaining either private insurance or joining an expanded Medicaid program, the bet is that more people who have inexpensive access to mental health treatment.
- People won’t be denied coverage based upon their pre-existing condition.
This is huge for many people with mental health concerns. Changing employers or insurance providers often meant having to pretend that a pre-existing psychiatric diagnosis didn’t exist. The new law says that you can’t discriminate against a person because of a pre-existing condition. This means that more people will get the care they need and have it covered by their insurance plan.
It also means an insurance plan can’t cancel your coverage for a pre-existing condition, something that was problematic for many in the past.
- People will get better overall care.
The law is designed to help increase incentives to physicians and other health and mental health professionals to look after people across the entire continuum of care — holistically, not just Patient X presenting with Z symptoms. It’s also focused on preventative care, which can help keep a person out of the hospital.
Research suggests that this sort of integrated, coordinated care is ultimately beneficial to the patient. It can help catch health issues before they become more serious concerns. It can also ensure that if a person gets a life-threatening diagnosis, they’re also seen by a professional for their emotional health needs.
- Medication coverage gap in Medicare remains filled.
If you’re a senior and enrolled in Medicare, the law has already helped save on your prescriptions. With the high cost of many psychiatric prescriptions, the law helped cut the amount a person pays for their name-brand drugs by half when they were in the “donut hole” (between $2,930 and $4,700 in total prescription costs).
This helps to ensure that seniors who need their psychiatric medications can continue to afford to take them.
The law, which will eventually expand coverage to 30 million Americans without insurance, will be implemented in pieces over the next five to 10 years. Some components of the law are already in place. These components include insurance companies being forbidden to put a lifetime limit on the amount of health care dollars they spend on any single individual, and insurance companies being forbidden to deny coverage to children with pre-existing conditions.
Overall, the Affordable Care Act will benefit mental health care, providing greater access to covered treatment options, including psychotherapy and medications.
7 comments
Here’s my prediction of PPACA survived past January 2013: first, psychiatry will be basically resigned to impatient care, community mental health outpatient services, correctional services, and addiction work (goodbye most outpatient care we know left now); second, EMR will demand psychiatric records be part of the full chart, as debated in prior post this week; third, formularies will make psychopharmacology return to the good old’ 1990s at best, as we already see big pharma retreat from new meds innovations; finally, we will see people with bare clinical degree certifications be pretty much the only therapy providers.
Here’s a shout out to my psychologist colleagues: your profession is almost as much at risk as mine! You think a politically driven change for health care management gives a crap about standards of care and maintaining a hierarchy of who provided it?!
With the insurance industry signing onto this garbage legislation back in 2010 and their history of decimating mental health services to now, you really think they will prioritize mental health care here on? You are clueless and/or delusional to say yes.
Mental health care is doomed if PPACA survives as is!!! Anyone who says this legislation is fine as is has no other primary priority than worrying about Democrat interests first and foremost. A couple of nice parts does not make it a proper whole!!!
With all do respect to the author (I appreciate his effort–and the inherent risk of stating an opion–in writing the article) I do hope this rose-colored picture is the outcome of the Affordable Care Act. However, I do not see the impact as one-sided (positive). I think there are going to be significant changes to mental health practice that will benefit some and harm others (careers, finances). In fact I am already seeing professionals in the field adjusting (trying to move to private pay, coaching, concierge or boutique services, and consulting) to try and prepare for the negative effects on private practices. Maybe I’m a cynic but I’ve often not been impressed with the government-run agencies I interact with (there are some notable exceptions of course) and I’m not willing to concede that this one will be a sterling example of efficiency or common sense. Just to be fair, I’ll write my own response (on my blog) and let everyone (the author included) who wants to take aim and my “jaded view.” Bryan
Patients already have a terrible time getting mental healthcare. Prices are too high and most doctors and psychologists, therapists, social workers do not take any insurance. The people who need treatment the most cant get it. The entire industry has moved to just acute hospitalizations and pills. Therapy at $150-200 or more per session is unaffordable. A psychiatrist visit is also several hundred dollars. A quality inpatient experience can cost $60K just for 1 month. Its unaffordable for everyone except the rich and famous
Until it is all implemented, we won’t really know how these changes will all play out, but to me it seems like there are lots of positive aspects to the act. I’m ready to give it a chance with the hope it will benefit millions of people.
Also finally in 2014 (its about time), Medicare will cover mental health at the same level as ‘physical health’ – 80/20. It used to be 50/50 for mental health and slowlly theyve been reducing the copay percentages. I am one of those on disability for mental health issues and getting healthcare has been extremely difficult. As it is, very few providers take Medicare. First off, they dont get much in terms of payment (probably 50% of what they normally charge)…Second, since most Medicare clients are elders, the way psychiatry deals with that these days is with short term acute hospitalization — not ongoing therapy. Psychiatrists exists for brief appointments where they provide a prescription. Ironically that appointment will often cost more than any other specialist – even an initial evaluation by a specialist. Even with the copay, Ive had psychiatrist appointments under Medicare cost $70. Ive looked into some inpatient or intensive outpatient treatment and most do not accept Medicare. The one program I was referred to cost nearly $2000 a day, which is more than my monthly Social Security payment. (because of the pre-existing clauses, when I was working full time and first went on disability, the insurance company denied my benefit becasue I had been to a psychiatrist before – evn though the psychiatrist had sent a letter saying the reason for the disability was totally different than the appointment they flagged. Also in general , the mental health disability was limited to 6 months while there was no such limit for physical conditions – forget that mental health is a brain disorder and last time I checked, the brain was a physical organ.
It ironic the politicians keep talking about the need for mental healthcare but no one will provide the funding. Most therapists charge anywhere from $125-200 per session. Most patients are recommended to go once per week. That becomes unaffordable for people who arent rich.
THe one posiitive thing is you can find a therapist who takes Medicare is unlike my previous experiences with private insurance, you don’t have to get preauthorizations for visits and you arent limited to the # of visits. But many of the therapists who take Medicare suck – or are doing that because they cant get patients of their own (This according to many therapists Ive talked to). They get less than $90 per session and have to go through a lot of paperwork and hoops – and often their reimbursements actually get lowered from year to year. I keep trying to find people and theres no easy way – many listed on the Medicare site are really just short term people working in hospital settings. The one Im currently seeing takes Medicare only because he does a lot of work with seniors. Im not a senior so not sure hes the right person for me & I just found him by accident
For Medicaid, we have to realize that a majority of states, many with GOP governors, have refused to accept t he Medicaid funding. Many of these are the states with the most poor, uninsured people. The REpublican state officials have also made it clear that they are doing everything they can to make sure Obamacare fails – including not setting up state exchanges. I know in my state, the Insurance Commissioner has been very open about wanting it to fail – to the point that some peole have already talked about filing a lawsuit