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6 ways ACA is changing mental health coverage

Most people who need such services aren't getting them. Here's how Obamacare tackles the issue.

By Money Staff Nov 27, 2013 2:25PM

This post comes from Beth Braverman at partner site The Fiscal Times.


The Fiscal Times on MSN MoneyAmerica's inadequate mental health care was thrust into the spotlight again last week, following the stabbing of Virginia State Sen. Creigh Deeds by his mentally ill son.


Elderly Woman Looking Out a Window © Keith Brofsky, Photodisc, Getty ImagesThe younger Deeds, who committed suicide after the attack, had undergone a psychiatric evaluation but was turned away by a local hospital due to a lack of space. Mental health experts say that a dearth of adequate services, as well as historically poor coverage by private insurers, has left millions of mentally ill individuals without the resources they need.


Americans spend $2.6 trillion a year on health care, but only a small fraction of that currently goes to treating those who suffer from psychological and mental health problems or from drug and alcohol addiction. Meanwhile, need is growing, as Americans deal with the emotional fallout of the Great Recession, veterans and their families struggle with their return to civilian life, and older Americans confront growing rates of depression.


Suicide claims the lives of nearly 30,000 Americans each year. Still, the majority of people who need services don’t get treatment. More than 60 percent of adults with a diagnosable disorder and 70 percent of children do not receive mental health services, according to a 2011 analysis by the Kaiser Family Foundation.


The passage of Obamacare has brought sweeping changes that will make coverage of mental health and drug treatment one of the "10 essential health benefits" that all insurers must offer. Insurers, patient advocates and state regulators are still hammering out specifics, but critics contend it will lead to an even greater shortage of services and that it doesn't do enough to address issues specific to treating the mentally ill. Many industry experts also aren’t sure what changes in the field of mental health will even be needed as new challenges arise.


"The reality is that the Affordable Care Act is not going to solve all of our health care problems, either for physical or mental health," said Ron Honberg, the national director for policy and legal affairs at the National Alliance on Mental Illness. "People are still going to struggle to get everything covered that they need to, but the inclusion of mental health care in this law is a huge step forward."


Here are six ways mental health coverage is changing under Obamacare:


1. Pre-existing conditions are now covered

Just as cancer survivors and diabetics are now guaranteed coverage under the new law, so, too, are those who have previously been diagnosed with chronic mental illnesses like depression or schizophrenia. One in four Americans suffers from a diagnosable mental disorder, with about 10 percent having a more serious mood disorder, according to the National Institute of Mental Health.


2. Insurance plans must offer parity of mental and physical health coverage

It's been more than five years since President George W. Bush passed the Mental Health Parity and Addiction Equality Act, requiring insurers to provide mental health care coverage comparable to their physical health care coverage. But experts say the law went largely unenforced until passage of the Affordable Care Act.


Now, if an insurer covers a certain number of visits to the doctor and a certain length of in-patient treatment for physical health, it must offer the same for mental health care.


"Where the law doesn't go far enough is in support service and'‘wrap around' services that are needed in the treatment of mental health," said Carolyn Wolff, senior partner and director of the mental health law practice at Abrams Fensterman in New York. "There's no coverage for residential housing, or case management needed for certain treatment."


3. There are limits on out-of-pocket spending

Even with insurance coverage, the out-of-pocket costs of in-house treatment can add up: The cost of in-patient treatment for the most severely ill mental health patients can quickly reach thousands of dollars. However, the Affordable Care Act limits total out-of-pocket spending at $6,350 for individuals and $12,700 for families starting in 2014 for "medically necessary treatment." Currently, a third of plans available on the individual market have out-of-pocket costs exceeding that limit, according to a study by HealthPocket.


4. Insurers must cover prescription drugs

Just as with mental health care, prescription drug coverage is an essential health benefit required under Obamacare. However, the specifics of such coverage vary by plan, with some insurers offering different types of coverage for "preferred" drugs, generics, or "specialty" drugs. For patients who regularly take a prescription medication to treat mental illness, it's important to check the insurer's formulary to find out exactly what’s covered.


"As with a health condition, switching among branded drugs, as well as switching among generic drugs, may or may not be effective, and that's a decision that should be made in consultation with a physician," said Judith Bentkover, a professor of health services, policy and practice at Brown University.


5. More people are getting treatment

Insurers began guaranteeing mental health and substance abuse treatment in 2011, and the number of people seeking such coverage skyrocketed. Substance abuse admissions increased 20 percent in 2011 among people younger than 65, and mental health admissions increased 6 percent, according to the Healthcare Cost Institute. (By comparison, medical/surgical admissions fell 2.3 percent.)


Such usage is expected to grow even further as more consumers have access to insurance under Obamacare and learn that mental health treatment is covered. More than 32 million Americans will gain access to mental health and addition coverage under the law, and another 30 million who currently have coverage will gain parity protection, according to the Department of Health and Human Services.


6. The already strained system isn't keeping up

As the Deeds case shows, there's already a shortage of psychiatric hospitals and psychiatric services to meet the country's needs, due to years of government cutbacks in mental health spending. There are only enough psychiatrists available to meet the needs of 53 percent of those who need services, with many more severe shortages in rural areas, according to an analysis by the Kaiser Foundation. Experts fear that as more people enter the system seeking help for mental health and substance abuse issues, the relative scarcity of providers will only get worse.


More from The Fiscal Times

Nov 27, 2013 2:48PM
6 ways Obama has changed the mental health of our nation:

1)  We're more dependent on gov and less self-reliant

2) We're more selfish and think total strangers are morally obligated to pay our own way

3) We're dumber - we think that if we don't have to pay for something it must be free

4) We're more likely to blame others for our own problems and less likely to accept responsibility and consequences for our own choices and actions

5) We're more jealous and hateful of those that have more than we do

6) We're now more fearful than ever before - of losing our job and/or our house, of the future of our kids and grandkids, of the loss of freedom, etc...

Nov 27, 2013 8:22PM
The new item on McDonald's menu is the Obamacare meal, you order it and the guy behind you in line has to pay for it.
Nov 27, 2013 9:15PM
I just wanted to keep my current insurance but can't due to Obama's lies.
Nov 27, 2013 8:45PM
The only way that obama got elected, was because of people with mental problems.
Nov 27, 2013 5:13PM
Also note that the ACA does not specify where you will get your treatment.  If there are no hospitals or doctors in your area that accept OBAMACARE, then you are SOL.  Just because you have insurance, there is no guarantee there will be a place to use it.  Are you getting the picture here.  Everything you were lead to believe by the President and his Democratic minions was pure fabrication.  You think it's hard to see a doctor now, it's only going to get worse.  This is what you get when you vote for Democrats and Liberals. 
Nov 27, 2013 8:54PM
Obama got elected because he cheated, using the irs to get info, and keep the conservatives from being able to donate money. he's a liar and a cheat.
Nov 27, 2013 8:22PM
Obamacare also changed the minimum stay requirements for many inpatient facilities from 8 weeks down to 5 weeks in order to accommodate more patients. As someone who works in the industry, we are seeing more and more individuals leave inpatient centers for depression, drugs, and eating disorders much too early for hopeful prognosis…. They know it and we know it, but we cannot do anything about it. 

Yes, more are getting treatment. NO the treatment is not better, but worse in order to accommodate for Obamacare. One of the major downsides.
Nov 27, 2013 3:22PM
You can put lipstick on the obamacare pig all you like. People have always had the option to seek mental health treatment, and pay for it, then question its efficacy. The fact that obamacare is covering mental health will only insure its failure, by allowing so many people to over consume a largely ineffective mental health system overly reliant on psychotropic medication intended to anesthetize rather than correct antisocial behavior. Trumpet this "advancement" if you like, but this is bound to generate mountains of invoices and expectations and produce little to nothing in results.   
Nov 27, 2013 8:26PM
Not going to matter much when ACA implodes now will it?
Nov 27, 2013 9:08PM
It's the affordability in ACA that's the problem.  We just got our statement from Humana and we got 2 wonderful choices: the first, stay with our current program with a $5K deductible or second, go with the ACA compliant policy with a $2.5K deductible.  Sounds great, President Obama has got us into a lower deductible.  The problem is the premium is 93% more!  It mathematically calculates as a $1 decrease in deductible paid for with a $2 increase in premium - for the EXACT same policy.  So, now we get a one-year reprieve and then God only knows what the premiums will be.  Remember the Wendy's "hamburger A or hamburger B"?  We got hamburger B.  But, the President's trying hard and that's what matters!  When is that last time you rooted for a winless football team that tries hard but never gets a good result?  In the real world they clean house and start over again.
Nov 27, 2013 9:21PM
Obamacare IS a mental breakdown...............................................
Nov 27, 2013 2:46PM
This article lists the mental health needs of returning veterans as a responsibility of the affordable care act, but this should be a VA responsibility.  Are we attempting to overstate the case?
Nov 27, 2013 11:20PM
People will not get the care they need because of high co-pays and deductibles. 

Its is simple as that people. 
Nov 27, 2013 9:57PM
Now he's putting off the small business part of the web site for one year, till after the 2014 elections.
there trying anything to get his yes men reelected and blame a lame web site for a really bad product that they all swear is better coverage than you ever had before the un affordable healthcare act. 
Nov 27, 2013 9:47PM
Our fear is that Obama-care will cause more mental fear and harm than what we had before.....even more folks will find themselves without health care. Just you wait and what little I have that I am right!
Nov 27, 2013 10:34PM
Did you ask about Obama's mental health?? They say that "ignorance is bliss" and so in Obama's case ... he must be happy as can be! His mental health is a joke .... since he's actually seems happy even though most of the country hates him and his Health Care Bill is a disaster and nobody wants it!! Please ..... idiot writers at NBC .... please don't try to tell me that his Bill is going to make some huge impact on the mentally challenged and therefore we should all, suddenly, be thrilled with the help it will do for all Americans everywhere!!! They must have the second string doing the writing tonight because the holiday writers are on the clock .... possibly you are hoping for better mental health yourself,  since you all seem to have mental health problems!! It shows in your writing!! Why is the U.S. so far down the list on countries that are happy .... it has nothing to do with their mental health care, it has to do with the countries they live in and since violent crimes has gone up 33% in the last year ... thanks Barry, I doubt some meds or payment to a DR will help the nuts in this country. Maybe a new Pres would help!
Nov 27, 2013 11:42PM
Great.   I get to pay more for less coverage/higher deductable and get to help others.   No different  than other government programs and not unexpected.   Too bad the insurance companies were not focused on with the ACA  versus the American people.    Bottom line is that most everyone will get less health care but all will have insurance.  Cannot wait for the Cadillac excise tax.
Nov 27, 2013 11:22PM

stop the alcoholism and the drugs. you will see that your health in general will be better.

oh... and stop waiting for others to take care of you. a self reliant person will not get crazy when broke. a welfare recipient loose his/her mind when the check is not in the mail..

Nov 27, 2013 11:32PM
Our current insurance covers all mental health diagnoses and treatment 100% with no copay. Just went through open enrollment and employer changed insurers. Next year, we will have a copay for mental health and only certain conditions are covered. Our child will not be covered for the treatment needed. Thanks Obamacare! Loved Aetna, hate UnitedHealthcare.
Nov 27, 2013 11:09PM
Obamacare is the result of an epidemic of mental libtardation in libtards/turds in America. It is a horrible disease, but I do not see why Conservatives should be expected to pay for all the the morons'  treatment. Especially for the ones who drank too much kool-aid and lobamatized themselves.

I would agree to pay for Obammy's messiah complex and libtardation treatment if he would check into an in-patient facilty and out of the WH for the rest of his term. We all know he is so sick that  it would take that long and this solution would help both him and the country.

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