The tragedies in Aurora and Newtown in 2012 sparked a lot of debate about America’s mental health policy. Despite vigorous debate on all sides, there’s been no clear solution yet.
However, a point that many seem to miss when debating the issue is the Affordable Care Act and just how much it will do for expanding access to mental health treatment in this country.
According to numbers from the National Alliance on Mental Health, it’s estimated that one in four adults experience a mental illness during the course of a given year. That’s about 55.7 million people.
So it’s no wonder that the Care Act would aim to extend and improve coverage for mental health treatment. Let’s take a look in some of the details.
1. You can’t be denied coverage because of a “pre-existing” condition.
Those suffering from mental illness have always gotten a raw deal because of this policy. But now its days are numbered.
Actually, it’s already been virtually eliminated. Following the March 2010 passage of the legislation, people with pre-existing conditions have been able to enroll in specially designed health insurance plans through state-by-state high-risk insurance pools.
By 2014, when the next big part of the Affordable Care Act becomes law, insurance companies will no longer be able to deny coverage because of a pre-existing condition.
2. More access to Medicaid.
One of the components of the Affordable Care Act was its plan to expand the Medicaid program. The expansion would give Medicaid access to people whose incomes are 133 percent of the federal poverty line or lower. Also, for the first time, single, childless adults would be able to apply. Medicaid has always provided a large selection of mental health treatments, many of which have been superior to the options provided by private insurance plans.
While the majority of the law was upheld by the Supreme Court last summer, the ruling did allow states to opt out of the Medicaid expansion if they so chose. At the moment, 26 states plan to accept the expansion, while 13 have announced they’ll reject it.
3. Mental health treatment comes standard.
If you’re not eligible for Medicaid, you will be able to purchase insurance at your state’s public health insurance exchange.
Every health plan sold through an exchange has to cover a variety of medical services in 10 “essential benefits” categories, which includes mental health and substance abuse treatments. The exact details of the treatments and services offered is left up to the states.
Going a little deeper into the legislation, though, we find that it requires mental health and substance abuse coverage to be on par with medical/surgical coverage. So even though we don’t know the specifics yet we can be sure that the coverage will be of a high quality.
4. Tax credits.
Depending on an individual’s income level, he or she might be eligible for a tax credit to help pay for insurance.
The credit is available to anyone purchasing insurance on the exchange whose yearly income falls between 133 and 400 percent of the federal poverty line (FPL). If you live in a state that didn’t go along with the Medicaid expansion then the floor for the tax credit goes down to 100 percent of the FPL.
There are a variety of calculators out there to help you determine if you qualify for a tax credit and how much it will be.
5. Preventative care.
People diagnosed with a serious mental illness are also at risk for other diseases such as diabetes and heart disease, which are preventable. The Care Act mandates that preventative procedures such as cancer and diabetes screenings, as well as routine checkups, be provided with no copays or deductibles.
An issue specific to those with mental illness is smoking. Studies have shown that those with a mental illness are up to 70 percent more likely to smoke than those without. Part of the preventive health care provided by the Care Act covers counseling to quit smoking and access to stop smoking aides.
The national debate over health care may never be resolved to everyone’s satisfaction. But we know that come 2014, at the very minimum we will see more people getting the care they need with less cost barrier.
While the Affordable Care Act may not be perfect, it is progress, which is always a good place to start.