Impact of Obamacare on the Mentally Ill

Maureen MurdockMental IllnessLeave a Comment

Barack Obama signing the Patient Protection an...

Obama’s re-election guarantees that mental health care will gain parity with physical health care under the Affordable Care Act (ACA).

ACA covers behavioral health for those now eligible to seek health insurance through a federal or state Exchange and in Medicaid. In other words, under the provisions of the new law people with low income (individuals at or below 133 percent of the federal poverty level-FPL) and those who cannot currently afford insurance will have greater access to an expanded version of Medicaid, the federal/state program for the poor and disabled. Behavioral health means both mental illness and substance abuse treatments.

Care for behavioral health will be available for millions of Americans with mental illnesses who currently do not qualify for Medicaid for a variety of reasons, including pending SSI applications, lack of a fixed address, or those with part time employment whose income may exceed current Medicaid eligibility levels. When my son applied for SSI, his application was denied two times in spite of multiple hospitalizations. We ultimately hired an attorney and eventually succeeded in his receiving SSI benefits after two years of rejections.

Although many of the law’s provisions will take years to fully implement the following is Psych Central’s analysis of the ACA as it pertains to mental health care:

Mental health care will become more accessible to more people

They will be included among those able to purchase federally subsidized health insurance policies in 2014 through state health insurance exchanges established by the ACA. And, these policies must cover mental health and substance abuse treatment at parity with other medical conditions. Parity is required, but unfortunately, no one really knows what that means as yet

People won’t be denied coverage based upon their pre-existing condition

Changing employers or insurance providers has often meant having to pretend that a pre-existing psychiatric diagnosis didn’t exist. The new law prevents discrimination against a person with a pre-existing condition but coverage for mental health is not required in employer-sponsored plans.

People will get better overall care

The law is designed to encourage physicians and mental health professionals to coordinate treatment across the entire continuum of physical and behavioral health care. Research suggests that this sort of integrated care is ultimately beneficial to the patient and can prevent hospitalizations. Teamwork is encouraged; however, it is not required.

Medication coverage gap in Medicare remains filled: Combating the infamous “donut hole”

Many psychiatric prescriptions are outrageously expensive. The law helps cut the amount a person pays for their name-brand drugs by half when they are in the “donut hole” (Between $2,930 and $4,700 in total prescription costs). This ensures that the individual who needs psychiatric medications can continue to afford to take them. The dreaded “donut hole” has always been a problem for our family. When my son had private insurance, there would be a point, usually in the fall, when he would fall into the donut hole and not be able to afford his medication. This often precipitated a manic episode.

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