Policy and Regulation News

How the Affordable Care Act Failed Mental Healthcare Coverage

By Vera Gruessner

- The Patient Protection and Affordable Care Act was meant to spread healthcare coverage to all Americans across the states. Health insurance, however, must also incorporate coverage for mental health and psychiatric care. Has the Affordable Care Act expanded mental healthcare coverage?

Mental Healthcare Coverage

The results don’t seem to be favorable and are mixed at best. The Washington Post details how the rehabilitation required to treat drug addiction can only be accessed depending on how much insurance companies will cover.

In fact, data from the federal government shows that deaths from heroin addiction rose by 39 percent from 2012 to 2013. While mental healthcare parity laws were fully implemented by January 2014, the results associated with these insurance regulations were found to be second-rate.

Even though the Affordable Care Act has brought more Americans healthcare coverage, it has not changed the way payers address some of the costs associated with mental health and medical services.

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  • Despite the fact that the Mental Health Parity and Addiction Equity Act of 2008 became law in order to ensure copays and deductibles associated with psychiatric care remained on the same level as medical care, many insurance companies have still not received adequate guidance from the government on how to incorporate the mandates of this Act into their health plans.

    “It turns out that people across the country are struggling to find therapists and psychiatrists who participate in their health insurance plans. They also face more frequent coverage and treatment denials from their health insurance companies for mental health care than for other services and must clear multiple hurdles to maintain a steady supply of mental health care medication,” the Washington Post reported.

    “Information about which services and treatments are covered and which medical providers participate in mental health care networks is often difficult to find before one is actually enrolled. And those determined to get some kind of mental health care or substance abuse treatment must often pay so much out of pocket that treatment becomes impossible.”

    A report from the National Alliance on Mental Illness found that the majority of Americans today still do not receive benefits from their insurance plans offering parity between mental and physical healthcare.

    The report finds that only 55 percent of psychiatrists around the nation accept any type of insurance. That means nearly half of the professionals within the psychiatric field do not work with health payers and leave those in most need of psychiatric care out in the cold.

    Additionally, the numbers of psychiatrists accepting Medicaid or Medicare coverage are even lower, Forbes reports. The study also uncovered the major reasons mental health professionals avoid working with insurance companies, which are the low fees and less paperwork associated with more direct payment sources.

    The study results also show that one out of five patients who have private insurance are unable to find a mental health provider within their coverage plan’s network. Plans under the health insurance exchange, which was established under the Affordable Care Act, find even more abysmal numbers – one out of four patients with a plan from the health insurance marketplace cannot find a mental health provider within their network.

    “Whether health insurance is obtained through employment or purchased by individuals through health insurance marketplaces, a significant percentage of respondents to our survey reported problems in finding mental health providers in their health plans,” the report stated.

    “The most significant problem identified was difficulty accessing therapists or counselors for outpatient mental health or substance use disorder treatment, followed closely by difficulties accessing psychiatrists.”