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The Truth About the Affordable Care Act and Mental Health Care

The Facts and Truth About ObamaCare or the Affordable Care Act and Mental Health Care

According to the U.S. Department of Health and Human Services, under the Affordable Care Act, almost 32 million people will gain mental health and/or substance use disorder benefits. Currently, children and adults with a mental health illness not only lack access to health insurance coverage, but also to adequate and necessary mental health care treatment. On the surface, it sounds like the Affordable Care Act will offer lots of positive benefits to children and adults with a mental health illness and how many of them will now be able to access necessary mental health care treatment. However, will there be any negative effects on either mental health care services or the adults and children who suffer with a mental health illness? Is the Affordable Care Act really as great of a program as it sounds?

Everyone should be allowed to make their own opinions about whether the Affordable Care Act will have a positive effect or a negative effect on mental health care services for themselves or their children. We have already formed our opinion, but before you read our opinion at the end of this article, please read these important facts about the Affordable Care Act and mental health care.


  • Parity was written into the law which should make mental health care coverage easier to access. Parity means that coverage for mental health issues must be comparable to general medical and surgical care coverage.
  • Coverage for people with pre-existing conditions (including mental health illnesses) will be available.
  • Insurance coverage cannot be denied or cancelled for an adult has or receives a diagnosis of a mental illness such as depression or bipolar disorder.
  • Children with a mental health diagnosis will no longer be denied insurance coverage.
  • Insurance coverage for children has been extended – children can stay on their parents’ health insurance policies as young adults, until they reach the age of 26.
  • There will no longer be any annual and/or lifetime limits on the amount insurers will pay for basic health care – this will also now include mental health and substance use disorders.
  • Financial help with both premiums and out-of-pocket health care costs is available to people with low incomes (those whose annual income falls between 100% and 400% of the federal poverty level).
  • Additional financial assistance may be available through a tax credit to people who purchase individual health insurance policies through the new state-run insurance exchanges (or marketplaces).
  • Medicaid coverage will be easier to access through the expansion of the program to include anyone living at or below 138% of the federal poverty line; however, specifics may vary from state to state.
  • Medicaid coverage must now cover mental health care and substance abuse care at the same level and price as other medical care.


  • Prior authorization is required for mental health care treatment.
  • People will receive only a specified number of "allowed" mental health care treatment sessions.
  • Representative Phil Roe (R-Tenn.), an ObamaCare opponent believes people should be aware that the health law cut funding for graduate medical education, which will hamper recent medical school graduates’ efforts to find residencies. This will in turn affect the number of available health care professionals.
  • Edward Coffey, CEO of behavioral health services for the Henry Ford Health System, has noted that the influx of new patients from the health law would strain the nation’s mental health workforce. Mr. Coffey says, "We now worry that we have the providers and the delivery system to take care of them."


  • The Affordable Care Act includes a provision for home visiting programs under §2951 (Public Law 111-148). This provision states that grants will be given to certain agencies to perform home visits. The agencies will identify those targeted for home visits; representatives from the agencies will then visit homes and intervene as they deem necessary (interventions can involve anything and everything from social and emotional skills, school readiness, and preventing injuries). The U.S. Department of Health and Human Services states that your family will be targeted for home visits if you fall into one or more of the following "high-risk" categories:
    • Families where children have low student achievement, developmental delays, or disabilities.
    • Families where someone is a tobacco user.
    • Families with individuals who are serving or formerly served in the armed forces, including such families that have members of the armed forces who have had multiple deployments outside the United States.
    • Families where mom is not yet 21.
  • Access to mental health care and mental health care professionals is worse than for any other types of medical services and medical providers. In 2010, the Bureau of Labor estimated that the U.S. had only 156,300 mental health counselors and that 89.3 million Americans live in federally-designated Mental Health Professional Shortage Areas.
  • According to the National Association of State Mental Health Program Directors (NASMHPD), since 2009 when President Obama took office, 3,222 psychiatric hospital beds are no longer available to patients (approximately 10% of all state psychiatric beds).
  • As a result of a decision by the Supreme Court, the Medicaid expansion is optional, and a large number of states are not participating. This means that some benefits will vary depending on where people live, and some people won’t see the full benefits accorded by the law.
  • Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness (NAMI), is somewhat circumspect about the upcoming changes, since we are still waiting for the final regulations – the government has promised this information by the end of 2013.
  • In a July 15, 2012 presentation, Joel Miller of the National Association of State Mental Health Program Directors stated that approximately 33% of all newly-insured people under the Affordable Care Act Medicaid expansion have behavioral health conditions. About 50% of this group could have a serious mental illness.


On the surface, the Affordable Care Act sounds like it could be a good thing. Who would argue that health care insurance for pre-existing conditions and mental illnesses is a bad thing? Financial assistance to pay for your health care insurance? Definitely can’t beat that! At first glance, it really sounds like the Affordable Care Act would be a great thing for everyone, but once you start digging deeper and looking into the nuts and bolts of it, you discover that most of what is being shared with us is just smoke and mirrors.

First, let’s look at facts about access to mental health care and mental health care professionals. In 2010, there were only about 156,000 mental health counselors in the U.S., and over 89 million Americans live in federally-designated Mental Health Professional Shortage Areas. Anyone who has dealt with accessing mental health care either for themselves or a loved one (and especially for a child) knows first how difficult it is to find a mental health care professional in your area, and secondly, how much time you have to wait to even get in for an initial appointment. I have heard from some parents who have had to wait 2 – 6 months to get an appointment with a mental health care professional for their child! Now with the Affordable Care Act, almost 32 million people will gain mental health and/or substance use disorder benefits. If we already have a shortage of mental health care professionals and a lengthy wait for appointments, how much more of a strain will this place on our mental health care system? Will we have enough providers to take care of everyone? Not only should we be concerned about if we have enough providers, but what about finding a provider who accepts the insurance you have? Many people have not already encountered issues with their current doctors not accepting the insurance, but then cannot even find providers in their area that will accept the insurance. What good is health insurance if you can't get anyone to take it? It is like having a check that you cannot get cashed at any bank.

The potential problem of the strain on our mental health care system to current mental health care professionals will be further compounded by the Affordable Care Act cutting funding for graduate medical education – this means we may not even have the possibility of adding new mental health care professionals to assist with the increased demand for mental health care services. This scenario doesn’t even take into consideration the number of psychiatric hospital beds that have been eliminated since 2009, nor the cuts that have been made to public mental health in the last few years. How exactly is the Affordable Care Act going to increase timely access to necessary and appropriate mental health care treatment? Doesn’t sound very likely – in fact, it sounds like it may make it even more difficult for people with a mental health illness to receive necessary and appropriate mental health care, let alone receive it in a "timely" manner.

The second thing to look at is that we are still waiting for the final regulations. Still waiting? So basically, we really have no idea exactly what we will be getting or won’t be getting. Who knows what might change between now and when we do have the final regulations, which the government has promised to deliver by the end of 2013? Of course, that is if the government can even deliver the final regulations by then. It should be very concerning that the government is forging ahead with forcing people to take part in a program that hasn’t even been finalized yet.

Of particular interest to many parents, especially those with children who have any type of disabilities (whether it is bipolar disorder, autism, or developmental delays) is the provision about "targeted home visits". Just how many people know about this? This isn’t something you hear about on the news – oh by the way, with all this good stuff you get with the Affordable Care Act, if you fall into what the government feels is a "high-risk" category, the government will be sending people to your home to intervene as they deem necessary. Your child has social-emotional issues? Your child has developmental delays? Your child has a disability? Surprise! Here comes a representative from a government agency into your home providing interventions. Surprise again! The government isn’t telling you what they consider as an intervention and what they will do if they determine your child or any other family member in your home is considered high risk, but you will have to do whatever they tell you. This is beyond concerning – this is scary. The government deciding that your child is considered high risk based on their disability, providing unknown interventions, and essentially deciding how you should parent and raise your child. One has to wonder what exactly is the purpose of these "home visits"? We already have doctors and other health care professionals asking us if we have firearms and/or knives in our homes. Are they planning on sending government agents into our homes under the guise of home visits to find out if we might have firearms and/or knives in our home? What will they do once they find out if we do?

As a parent of a child with multiple disabilities, including a mental health illness, I don’t like the Affordable Care Act. I had a difficult time in the past accessing mental health care professionals for my son that were both in my area and also didn’t have a waiting list of two months or more. I worry that if my son needs emergency mental health care, I won’t be able to get this provided for him. I have already worried about and dealt with people who don’t understand a child with a mental illness or even the mental illness itself. Now I am going to have to worry about dealing with government agencies who want to come into my home, who most likely will have no experience or background whatsoever in mental illnesses, and try to tell me what to do with my child. I am my child’s parent. I know my child best. I am the one who should decide what types of interventions and/or treatments my child needs, not some government employee. Not only do I not like the Affordable Care Act, but all the unknowns and the possibility of someone else telling me how to raise and care for my child scares me to death!


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