What Will Mental Healthcare Look Like if the ACA is Repealed?

Last Thursday, the U.S. Senate took the first of many steps necessary to dismantle the Affordable Care Act–voting 51-48 in favor of repealing Barack Obama’s landmark health insurance program.

It’s an action that would eliminate healthcare coverage from nearly 20 million Americans, a number of which have been aided by mandatory coverage for mental health services under the ACA.

A majority of insurance plans sold through the Affordable Care act were required to offer a number of essential health benefits for those surviving with a mental illness, including therapy, medication, and preventative measures. In addition the ACA ensured that individuals with preexisting conditions could not be denied coverage.

As an image from the official White House twitter page mentioned last week, repealing the affordable care act has drastic consequences for those with mental health conditions. “Affordable coverage would not be available [to all], leaving mental conditions like bipolar disorder undiagnosed and untreated.”

This is a huge issue, especially when you retrospectively look at what mental health coverage consisted of in years before the ACA, to find that in 2013, a person with a bipolar diagnosis was unable to obtain private insurance in a majority of states.

Recently, The American Psychiatric Association (APA) issued a letter to congressional leaders, in an effort to advocate for those with mental health and substance abuse disorders.

Writing on behalf of over 36,500 psychiatric physicians across the U.S., the APA wrote that they supported expanded access to quality mental healthcare services for those suffering from psychiatric or substance abuse disorders. This number encompasses nearly 20 percent of the American population.

“Individuals with bipolar disorder, schizophrenia, major depressive disorder, substance use disorders, and other mental health issues previously struggled to obtain insurance coverage to help them access care,” APA President Maria A. Oquendo and APA CEO and Medical Director Saul Levin wrote. “Current law changed that by requiring coverage of necessary services to treat mental illness. Consequently, it has become less burdensome for Americans to access appropriate and evidence-based mental health care, thus improving their chance for healthier and more productive lives while reducing the stigma around mental illness.”

As noted by the APA, insurance coverage drastically helps those who are struggling from mental and substance abuse disorders receive the healthcare treatment they need to remain productive members of society.

The Affordable Care Act also revolutionized how mental health stigma was perceived. While treatment in the form of therapy and medication are the most common ways of managing mental health disorders, stereotypes about treatment often prevented people from seeking professional medical help. In this sort of sense, requiring mandatory coverage showed, for the first time, that mental health was a critical and component of holistic health.  

Of course, the ACA wasn’t a perfect solution for those coping with mental and substance abuse disorders. The shortage of available healthcare providers has been a significant issue for patients suffering from a vast number of illnesses, as has been the challenge of finding a professional in a patient’s area who would accept their insurance.

For now, predicting what will happen should the ACA be repealed is speculative, at best. Other bills, such as the landmark 21st Century Cares Act enacted last December may help ease the gap in coverage if the ACA is repealed.

As it stands, Republicans have no concrete plans put forth that would replace the Affordable Care Act, but many are hoping that the gains established under the Obama administration are not undone for partisan reasons.

As APA Oquendo and Levin addressed in their letter to Congress, “As Congress considers significant reforms to health insurance coverage this year, it is critical that any such reforms do not undo the gains which have been made over the past several years for individuals with mental illness, and that any such reforms only further enhance coverage and access to lifesaving evidence-based care.”

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