Photo by Marek Studzinski on Unsplash
In the past, many health insurance plans weren’t too kind to people with mental illnesses. Until the Affordable Care Act (ACA) came into effect, 28 states in America had no requirements that individual market plans cover or offer any mental health services to patients. Now, as of 2014, most individual and small-group health insurance plans, including those on the Marketplace, must cover mental health and substance use disorder services. How has the ACA impacted mental healthcare today? Moreover, how has this impacted minorities who suffer from a mental illness? What future improvements to treatment access must we make? Before we examine these questions, let’s briefly take a look at how mental healthcare was covered before the ACA.
How Mental Healthcare Was Covered before ACA
Before the ACA came into effect, many people with mental health illnesses were more likely to be uninsured. Two parity laws, known as the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008, were in place that required all large-group employer insurance plans to cover mental health services as much as medical and surgical services (if these were offered).
While these two laws applied to the large-group plans, they didn’t apply to individual and small-group health plans. The underwriting protections through HIPAA were insufficient. Therefore, changes needed to be made to expand insurance coverage for mental health services.
The ACA’s Impact on Mental Healthcare
That was when the ACA came in. Consequently, most individual and small-group plans were required to cover mental health and substance use disorder services. In addition, plans on the Marketplace were required to add these treatments to their list. Other efforts included allowing young people to stay on parents’ plans until they turned 26 and expanding the Medicaid program. As a result, the number of uninsured patients dropped in 2018.
Because of the ACA, many people with mental illnesses were more likely to be insured. For instance, one study showed that the expansion of Medicaid was associated with coverage improvements for people diagnosed with depression. Furthermore, it has also been associated with reduced severe stress. In Medicaid expansion states, several studies showed improved overall insurance access among low-income adults. Another study also showed low out-of-pocket healthcare spending from this group.
Gaps in Minority Care Need to Be Improved
While the ACA has certainly brought about some improvements in insurance coverage across mental healthcare, there is still room for further improvement. In particular, there remains a disparity in mental health care among ethnic minorities. This is due to inadequate access to healthcare and limited economic opportunities for these groups. Specifically, African-Americans and Hispanics are likely to experience these limitations.
In addition, we need to have more large-group plans with mental health coverage. Many of these group plans are still not required to have this. There have also been several reports flagging mental health adequacy issues. Reportedly, 113 million people live in areas without mental health clinics or providers.
There are still a lot of things we need to do to increase mental healthcare coverage among patients. We don’t know what’s in store under this new presidential administration. Hopefully, things will start to improve and mental healthcare insurance coverage will increase for everyone. In the meantime, our Mental Health Service Providers have plenty of information on where to find quality mental healthcare for you or a loved one.
