The recent election and impending repeal of the Affordable Care Act (ACA, “Obamacare”) once again casts a cloud of uncertainty over our healthcare system. Our team is concerned about the impact that repeal would have on people with mental illness. The Trump administration, however, has indicated that certain popular portions of the ACA may be left in place. This creates an opportunity for advocates to fight for the ACA’s extensions to mental health care, especially as this has historically been a bipartisan issue. These provisions include:
Mental health parity extensions to the individual and small group markets: The ACA extends the 2008 Mental Health Parity and Addiction Equity Act signed by President George W. Bush to an additional 62.5 million Americans. This requires equal coverage and cost for mental and physical treatments, thereby preventing insurance companies from discriminating against people with mental illness.
Inclusion of mental health and substance abuse treatment as an Essential Health Benefit: For the first time, this requires all individual and small group insurance plans to provide mental health and substance abuse treatment. This also bans annual or life-time treatment limits.
Allowing children to stay on their parent’s insurance until age 26: This increases insurance coverage for young adults, which is important because many of the most severe forms of mental illnesses like schizophrenia and bipolar disorder first emerge in this age group.
Banning discrimination based on preexisting conditions: Insurance companies used to exclude the sickest patients by charging them very high premiums or rejecting their applications for coverage outright. The ACA bans both of these practices, which were frequently used to target people with mental illnesses.
Expanding Medicaid and the social safety net: These provisions are particularly important for people with mental illness who are disproportionally represented in the vulnerable population served by Medicaid. These expansions address some of the root causes of homelessness, incarceration, unemployment, and inequalities in care. John Kasich and Chris Christie both chose to expand Medicaid in their states along with nearly a dozen other Red states including Mike Pence’s Indiana.