By Maya Horowitz
Andrew Mackay pays $454 a month for mid-range health coverage. The 23-year-old Menlo Park resident does not smoke, he is not obese, and his blood pressure is normal. He said his insurance costs so much because he was diagnosed with a bipolar condition at age 15.
Before Congress passed the Affordable Care Act, Mackay worried that his future in the health insurance system would be “terrifying” due to his pre-existing condition. Now that he’s able to stay on his parents’ plan until he is 26 and get a significantly lower rate ($309 a month), he said, “I feel transitioning into my twenties is doable. It’s not as imposing as it was.”
Mackay is one of about 1.2 million California adults who live with some form of mental illness. Nationwide, the numbers are staggering. “In any given year, one in five adults experience a mental illness,” President Obama said at the National Conference on Mental Health in June. “Forty-five million Americans suffer from things like depression or anxiety, schizophrenia or PTSD. … Today, less than 40 percent of people with mental illness receive treatment.”
Obama’s signature health care legislation addresses this problem in explicit terms. Under the law, which takes effect Jan. 1, mental health and substance abuse services are classified among the 10 “Essential Health Benefits.” Health insurance marketplaces cannot apply yearly or lifetime dollar limits on coverage of these benefits. The marketplaces also cannot deny anyone coverage or charge more for pre-existing conditions.
“Pre-Existing Condition: A health problem you had before the date that new health coverage starts.” -HealthCare.gov
Nancy Pena, the director of the Santa Clara County Mental Health Department, explained that “individuals will have more choice regarding the plan they want, the coverage they receive and the providers they want.”
Under the ACA, health plans are required to cover preventative services, including behavioral assessments for children, at no additional cost. Coverage will also include behavioral health treatment, such as psychotherapy, and substance abuse treatment – both for inpatient and outpatient care.
Building on the Mental Health Parity and Addictions Equity Act, the ACA requires insurers to guarantee that financial requirements like co-pays and deductibles, as well as limits on doctors’ visits and care management, are no more restrictive in the behavioral health field than requirements or limitations on other medical or surgical benefits.
“This is really a very significant part of the ACA for us,” said Stephen Kaplan, the director of San Mateo County Behavioral Health and Recovery services.
San Jose-based Marriage and Family Therapist Irene Capuchino agreed. “Mental health needs have been seen as a secondary or even luxury add-on,” she said. “The stigma around receiving mental health therapy, or the belief that ‘good’ or ‘intelligent’ or ‘normal’ people never need mental health treatment negatively impacts our collective ability to even acknowledge the need for mental health services. Hopefully the ACA’s parity clauses will be a beginning step towards acknowledging and appreciating the value of mental health treatment services for people who need them.”
Specific behavioral health benefits vary from state to state. According to the National Alliance on Mental Illness, California offers limited parity and covers serious emotional disturbances in children and severe mental illness for all patients.
“A serious mental illness, a categorization for adults age 18 and older, is any mental illness that results in substantial impairment when carrying out major life activities.” -California HealthCare Foundation
Kaplan said the Affordable Care Act will not make a large difference for the seriously mentally ill. Those who fit the legal definition of severe mental illness already qualify for disability. Those who struggle with substance abuse, on the other hand, laud provisions in the ACA that classify substance abuse treatment under the umbrella of mental health.
Overall, Kaplan said, the law’s impact on mental health treatment is “definitely a very, very big net positive.”
To learn more about the ACA’s impact on mental health care, visit these resources:
- www.mentalhealth.gov – Run by the U.S. Department of Health and Human Services
- www.whitehouse.gov – The official site of the executive branch of the US government
- www.healthcare.gov – The national health insurance marketplace, run by the U.S. Centers for Medicare and Medicaid Services
- www.samhsa.gov – Substance Abuse and Mental Health Services Administration
- www.coveredca.com – The California health insurance marketplace, Covered California
- www.chcf.org – California Healthcare Foundation
- www.sccgov.org/sites/mhd – Santa Clara County Mental Health Department
- www.smchealth.org/bhrs/mh – San Mateo County Mental Health Services
- www.kff.org – Kaiser Family Foundation, focusing on US health care issues
- www.nami.org – National Alliance on Mental Illness
Peninsula Press reporter Vjeran Pavic contributed to this article. Video produced by Vjeran Pavic and Maya Horowitz.