Has the Affordable Care Act really made mental health care more accessible?

Affordable Care ActWhen the Patient Protection and Affordable Care Act was enacted in 2010, Americans wondered how the legislation would affect health care options for the average citizen. Proponents envisioned wider access to treatments for conditions that were either too expensive or too rare to offer to patients before. Detractors of the ACA imagined a health care system overwhelmed by an influx of new patients.

When it comes to mental health care, neither of those possibilities have come to pass. Instead, access to treatment for mental disorders has seen unequal change across the U.S. as a result of the ACA. While patients in some states have experienced widespread access to vital treatments, medical professionals in other parts of the country are waiting for people to walk through their doors.

Pennsylvania starts slow
Inadequate insurance coverage kept many people from seeking help before the ACA. Now that behavioral health is listed among the 10 essential benefits that insurance plans must cover, the natural conclusion is that more patients should be seeking treatments they no longer have to pay out-of-pocket for. However, The Philadelphia Inquirer reported that there has been no substantial increase in patients at mental health facilities across Pennsylvania.

“It’s very early,” Patricia Kleven, director of outpatient mental health services at the Philadelphia-based Belmont Center for Comprehensive Treatment, told the news source.  “I don’t know what it will look like in six months or a year. But at the moment, not so much.”

Now that behavioral health is listed among the 10 essential benefits that insurance plans must cover, the natural conclusion is that more patients should be seeking treatments they no longer have to pay out-of-pocket for.

However, Joseph Rogers, chief advocacy officer for the Mental Health Association of Southeastern Pennsylvania, told the Inquirer that a frustrating loophole of the modern insurance system is keeping thousands of Pennsylvanians from the care they need.

“The main issue is the Medicaid gap,” Rogers told the news source. “If you don’t have private insurance and you are not poor enough to be on Medicaid, it is very difficult to get behavioral-health services because not enough people provide it on a sliding-scale basis.”

Many of the patients that Rogers treats have severe disorders such as schizophrenia and depression that keep them from holding steady jobs. These people do not normally qualify for coverage from work, yet do not earn enough to qualify for a tax credit when they sign up for insurance through Healthcare.gov, the online face of the ACA.

Young people feel healthier
While Pennsylvania residents may be waiting for greater access to medical care, a survey conducted by Harvard University researchers indicated a different trend on the national scale: Adults between the ages of 19 to 34 years old reported feeling healthier in several categories, including mental health. The researchers pointed to the ACA’s coverage expansion for young adults as the primary cause of the increase.

The survey received responses from 26,453 individuals between 19 and 25 years old – the newly covered age group under the ACA – and an additional 34,052 people between 26 and 34 years old. The respondents indicated a 6.2 percent improvement in their overall health, as well as a 4 percent increase in their mental health status due to the expanded coverage under the ACA.

Kosali Simon, professor of economics and contributing author of the survey, explained that the true measure of health care reform is patient outcomes, and the ACA appears to be working when it comes to mental health treatments.

“We eventually judge all these [insurance] expansions based on the final outcomes that we care about,” Simon said in a statement. “How did this affect the well-being of young adults? Is there a measurable improvement of health status? Does it appear that there is better mental health as a result of this increase?”

According to the survey, the answer is yes, the ACA has benefited many young people in search of care. However, the struggles that patients living in Pennsylvania and other threatened by financial loopholes face means that more work is still necessary to improve the accessibility of mental health treatments for those in need.


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