The Limitations of The Affordable Care Act on Behavioral Health Treatment

Mental health has become an increasingly important topic on a national and international level. With the numbers showing that 25 percent of all U.S. adults have a mental illness and nearly 50 percent of U.S. adults will face a mental illness of some kind in their lifetime, behavioral health is taking center stage in political arenas and at dinner tables across the country.

With the election in November quickly approaching, many are taking a closer look at how far we’ve come in addressing mental health needs with the passing of the Affordable Care Act, where we’re lacking and the direction we’re heading.

A Monumental Step for Behavioral Health Care

Providing one of the largest expansions of mental health and substance abuse coverage in a generation, the Affordable Care Act (ACA) marked a significant (and much needed) milestone in the fight for mental health reform. Requiring the majority of individual and small employer health plans to cover mental health services as one of 10 “essential benefits”, meaning all health plans sold in the new exchanges and Medicaid must include it, the passing of the ACA signaled a growing acceptance that as more and more people confront mental illness, insurers need to start treating mental health and physical health as one in the same.

Historically, they haven’t, even though, according to the CDC, mental illness is associated with increased occurrence of chronic diseases such as cardiovascular disease, diabetes, obesity, asthma, epilepsy and cancer. Under the ACA, mental health care needs are deemed as no different than treatment for cancer or a necessary surgical procedure.

“The ACA has been transformative in so far as that we were able to get mental health and addiction considered as an essential health benefit,” said former Rep. Patrick Kennedy, a recovering addict who co-authored the Mental Health Parity and Addiction Equity Act of 2008. “We are no longer considered an afterthought.”

Significantly, health plans are also forbidden from rejecting people with preexisting conditions, including mental illness and addiction, enabling many to receive coverage who previously would have been denied. This is a huge feat considering drug overdose is now the leading cause of accidental death in the US, with opioid addiction driving the epidemic.

The World Health Organization reports that mental disorders are estimated to occur twice as frequently among the poor compared to the wealthy and that poverty increases the risk of mental illness. Subsequently, having a mental illness increases the risk of descending into poverty. The Medicaid Expansion under the ACA was a contributing factor in helping low-income individuals, the most vulnerable population, receive treatment for behavioral health issues.

Arguably, the ACA helped break down many of the barriers prohibiting people in need of behavioral health care from receiving it because their malady wasn’t viewed as important enough to insure. Now, theoretically, whether someone has a broken leg or is among the 14.8 million American adults suffering from depression, covered treatment should be a right.

So, why is research indicating that most of the people afflicted with behavioral health issues are still not getting treatment?

A Long Road Ahead

While progress is clearly being made, a report released last year from the National Alliance on Mental Illness (NAMI) indicates we have a long road ahead to achieving true parity in behavioral health care.

NAMI’s research revealed major barriers for individuals trying to find quality care for mental health and substance abuse issues. Among them, serious difficulty getting access to mental health providers and therapists who participate in health insurance plans; high rates of denials of behavioral health care compared to other health services by insurers; limited coverage for prescription drugs; and high co-pays and deductibles.

According to Politico, a serious shortage of behavioral health specialists and a dwindling number of clinics and hospitals, particularly in rural areas, designed to treat and house people with serious mental illness, may be contributing to the fact that most people in need of care, still aren’t getting it. Additionally, a report from the CDC confirmed that although more adults with severe psychological disorders have health coverage, many are still not receiving treatment due to the high cost.

Even though a big part of the ACA was that behavioral health needs be treated on a par with  other diseases, enforcement of that critical component has been weak, if enforced at all.

Maria Oquendo, president of the American Psychiatric Association stated, “Many of the insurance companies have stepped up on paper and have made statements about embracing the law. The truth of the matter is there still are significant difficulties.”

Even President Obama has acknowledged gaps in care remain. “We have made progress expanding mental health coverage and elevating the conversation about mental health.” But, he added, “Too many people still do not get the help they need.”

Where We Go From Here

Never has there been a more critical need for behavioral health care reform with the country deep in the throes of a drug epidemic and millions experiencing some form of mental illness. The ACA helped to get the conversation rolling, and undoubtedly boosted the number of Americans with health insurance–a huge step in the right direction. Yet, as the NAMI report revealed, it has not resolved the fragmented way many insurers treat the costs of behavioral health treatments, alienating a growing number of people who were promised and desperately need care.

So where do we go from here? What the future holds for the ACA and behavioral health care reform remains to be seen. Much depends on who moves into the White House on January 20. But the research is telling us that more work is needed to ensure that what was promised under the law is actually delivered.

Breakthrough technological advancements, studies and cutting-edge therapies are showing promise for treating behavioral health issues, provided there is access for patients.  

Elevating the conversation is a great start but actions speak louder than words. We’re sure the 42.5 million adult Americans living with a mental illness and the 19.7 million suffering from addiction would agree.