The Affordable Care Act (ACA) will begin this fall in the United States, with the health care exchange signups at the state level. So it’s a good time to pause and reflect. What would an ideal American mental health system eventually look like, and could we get an idea or two from our friends? (We will not be fully serving the mental health needs of the U.S by 2014, when the law becomes operational, but we will be much closer than before.)
There are definite distinctions between the two countries, something those in positions of policy and advocacy in both systems certainly refer to and highlight.
Every person in the U.K. indeed has some form of health coverage. (This in itself, even before dissecting mental health services, is of course distinctive and cannot be stressed enough.) Their definition of health coverage, more to the point, has included mental health.
Debbie Plotnick, who could definitely be described as a policy pro at Mental Health America, gives details that essentially clarify the U.S policies as being in the Dark Ages until 2008, when the Affordable Care Act was signed into law. Only with its passage can the U.S. system even be considered similar to the U.K.
“It’s been very difficult… ” Plotnick begins. “Until 2008, it was legal for U.S. insurance companies to completely deny services for mental health treatment. They would just not cover them.”
The ACA is in the process of changing that with the Mental Health Parity Act, covering mental health and substance abuse. Final regulations will go into effect by the end of the year. Plotnick is confident this component will happen. Many mental health advocates across many states are not so sure, though, and have been nervously lobbying legislators not to push for an about-face.
So if all goes well, the Affordable Care Act will get most individuals in the U.S. health insurance. (The U.K. will still be ahead of the game by covering all.) Mental health in the U.S., too, would finally be a part of health coverage, as in the U.K.
Plotnick expands on this by discussing the private/ public battle so prominent in the U.S. health system. She refers as “patchwork” not only the state/ federal tug of war on policy issues, but also that between private insurers and the public system.