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The Loss of the Affordable Care Act May Be Catastrophic for Mental Health

As Republicans move to gut Obamacare, patients seeking mental-health care — coverage that’s already spartan — find themselves with even fewer options to turn to.

By Lauren Saccone


(Photo: Nicole Mason/Unsplash)

One of Congress’ rare bipartisan victories under the Obama administration was the 21st Century Cures Act, a bill hastily passed last December that, among other provisions, intended to allocate $6.8 million to mental-health services and expand access to services on both a federal and state level. Despite the bill’s financial pittance, as well as mounting complaints that other provisions within the bill adversely affect Medicare while aiding pharmaceutical companies’ bottom lines, the 21st Century Cures Act was hailed as a symbolic, yet necessary, victory for a divided Congress. The message was clear: mental health matters.

But now, as the Trump administration’s contentious health-care bill comes to a vote on the House floor later today, Congress finds itself more divided than ever — even within the Republican Party itself. With less care at higher costs, constituents of all political leanings are worried about what a change could mean for their coverage: a group that includes the millions of people who rely on Obamacare for their mental-health treatment. Roughly 42.5 million Americans deal with mental illness each year; about one out of five adults. What would this change mean for them?

Living with mental illness has never been easy, but proper health-care support can go a long way toward easing the burden. For the past eight years, people living with mental-health issues have been able to turn to the Affordable Care Act for aid and support; but all that could beabout to change.

For those suffering from mental illness and addiction issues, the ACA has proven something a revelation: Health concerns were not only acknowledged as real illnesses — in most cases they were covered by insurance. But the changing tide of health care and the new restrictions spell trouble for those dealing with mental-health issues. An end of Obamacare and a new era of Trumpcare would spell uncertainty for Americans with mental illness.

Accessibility has long been a huge problem for those dealing with mental-health issues. Oftentimes, their conditions simply weren’t covered. Sometimes their illnesses were dismissed entirely, treated as nothing more than melodrama or a flight of fancy. Even if there were potentially helpful treatment options available, patients had no way to access them.

“The ACA expanded what was required of individual plans and small group insurance programs,” explains Dana Venable, a licensed mental-health counselor at the Counseling Services of Greater Boston. According to Venable, the ACA required that mental illness be covered just like any other medical problem — at a comparable cost.

“I’m job hunting but having trouble finding anything that offers insurance or pays enough for me to be able to afford alternative insurance coverage.”

Treatments for mental illness isn’t cheap. Every year the direct cost of treating mental illness is around $55 billion. Indirect costs associated with mental-health issues run even higher, around $273 billion. This includes lost employment, decreased productivity, social welfare programs, and accidents. Of that $273 billion, $70 billion is the estimated cost of mental-health issues that were not being treated. The ACA gave many people coverage they had never before experienced for their mental-health problems.

But it might not be this way for much longer. On January 20th — just hours after he assumed the presidency — Donald Trump issued the executive order to begin rolling back the ACA. Although this does not change the law surrounding the health-care program, it does effectively begin the end of the ACA as we know it.

On January 27th, House and Senate committees presented a blueprint for going forward with a plan to end the ACA. This will not happen overnight; dismantling it will take time. Trump’s team is very aware that millions of Americans are more than a little leery about the idea of losing their health insurance. They’ve repeatedly assured the public that a new plan is on the way that will provide coverage for all Americans.

As part of its rewrite of Medicaid, the Republican health-care plan removes the mandate for mental-health and substance abuse coverage. Policy holders are scrambling to have a back-up for when the ACA ceases to provide them with health care. While this is a terrifying situation for anyone who has to ponder a future without health insurance coverage, it’s causing particular panic among those dealing with mental illness. People with mental-health issues often find themselves in a uniquely difficult position in regards to health-care concerns; that’s because, by and large, mental illness doesn’t operate the way many other diseases do.

“The nature of being mentally ill makes accessing services more difficult than seeking treatment for a physical ailment,” Venable says. “Someone struggling with a mood disorder would have a harder time feeling organized and motivated enough to call a clinic to make an appointment. The more road blocks, the more difficult accessing those services becomes.” According to the Substance Abuse and Mental Health Services Administration, 60 million Americans received mental-health care in 2016 thanks to the increased access brought about by the ACA. While certain areas still struggled to achieve coverage for patients, it was a significant step in the right direction.

“When the smaller group and individual insurance stop offering mental-health benefits, the effects on people with diagnoses like schizophrenia, bipolar disorder, eating disorders, and major depressive disorders could be devastating,” Venable says. “Without access to preventative mental-health treatment, we will be looking at more mental-health crises, hospitalizations [which are exponentially more expensive than outpatient, preventative care], suicides, and homicides.” A report by SAMHSA found that, of all the people who die by suicide, 90 percent suffered from a diagnosable mental illness.

There’s also the trial-and-error system of receiving a proper diagnosis, dealing with negative reactions to medication, and getting the proper treatment. It’s a difficult process, as anyone who’s struggled with mental illness can attest. And this doesn’t just impact people under the ACA — even people who had their own health insurance could visit a physician without fear of being denied treatment.

“I was going to therapy in 2015 and stopped going because my new plan would no longer cover it,” says Rebecca (not her real name), a freelance writer who has been on the ACA since its inception. “On my original plan I only had a $15 copay for outpatient mental-health services, which was fantastic, but the more restrictive plan I was forced to choose in 2016 because of the price increase either didn’t cover outpatient mental health or only covered a fraction of it once I met my deductible [which came to about] $4,500. I wasn’t in crisis, so it was OK for me to stop going to therapy but if I had had a more serious mental-health issue it would be catastrophic.”

The program was streamlined and improved over the years, and gradually public approval increased. In fact, a poll by Fox News released in January shows that the ACA is actually more popular than our newly minted president (50 percent approval rate to 42 percent, respectively). Despite widespread public approval, even among those who overall opposed the universal health-care plan, Republicans remain determined to change the law regarding pre-existing conditions.

Unfortunately, there don’t seem to be a lot of alternatives besides simply paying cash for treatment. And without insurance, that can end up being prohibitively expensive for a lot of people. An initial psychiatric session can cost up to $500, with regular visits averaging about $100.

With this enormous bill looming, many people are becoming increasingly panicked about their options. Some may even opt to reduce their medication or stop taking it altogether — which can be incredibly destructive for them and their loved ones. But faced with crippling debt for health care, some will choose the more financially viable option. Others are looking to more unconventional methods of getting health care.

“[The ACA] getting repealed may be a death sentence for me,” says Jessica (not her real name), who relies on the ACA Medicaid expansion for her health-care needs. “I’m job hunting but having trouble finding anything that offers insurance or pays enough for me to be able to afford alternative insurance coverage. I am applying to graduate programs and studying for the GRE to prepare for not having health care. The health care offered in graduate programs may not be great, but it’s something.”

The fight for a new health-care program isn’t just about politics; it’s about the lives and mental well-being of millions of Americans. Already struggling with the stigma and prejudices surrounding their illness, patients seeking mental-health care must now do even more to get the coverage they need for daily survival. And despite the ongoing promises of a solution, one still is not forthcoming.

“Although I think it’s a flawed policy, I am absolutely not in favor of repeal and I don’t know what I’ll do if it is repealed,” Rebecca says. “I really don’t have a plan B yet.”

The loss of the ACA is leaving a gigantic void in its wake. It will be felt by anyone who has turned to the ACA for health insurance, whether for a medical emergency or a chronic condition. Without the ACA to turn to, the future looks uncertain for those struggling with mental illness — and that uncertainty may linger for a very long time.