Before the Affordable Care Act (ACA) was enacted, mental health coverage was often lacking from health plans sold in the individual market. One in five American adults will experience a mental health issue at some point, but historically, millions have not gotten the care they needed due to the challenges of the health insurance market.

And in recent years, the opioid epidemic has cast a spotlight on the need for substance abuse treatment, which falls under the umbrella of mental/behavioral health care. Medicaid expansion — a cornerstone of the ACA — has dramatically expanded access to addiction treatment in some of the states that have been hardest-hit by the opioid epidemic.

Parity Laws – a good first step

In 1996, and again in 2008, Congress passed mental health parity laws, requiring large group plans that cover mental health treatment to do so with benefits that are no less favorable than the benefits provided for medical/surgical care. The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) incorporated coverage for addiction treatment as well as general mental health care.

However, they only require the plans to provide parity if mental health and addiction treatment coverage is provided. And parity laws didn’t apply to plans sold in the individual and small group markets.

The Affordable Care Act filled in the gaps

The Affordable Care Act was a turning point in terms of access to behavioral health coverage. The ACA eliminated medical underwriting in the individual and small group markets starting in 2014, so an individual’s medical history — including mental health history —no longer results in enrollment denials or higher premiums.

And under the ACA, all individual and small-group plans with effective dates of January 2014 or later are required to cover ten essential health benefits with no annual or lifetime dollar limits. Mental health and addiction treatment (collectively referred to as behavioral health services) are among the essential health benefits.

Prescription drugs are also an essential health benefit under the ACA. Thanks to the ACA, all new individual and small-group plans cover prescriptions, including medications to treat behavioral health problems.

Young adults get insured

In 2010, the ACA began allowing young adults to remain on their parents’ health plans until age 26. This provision has resulted in a sharp decline in the number of young adults without health insurance.

But it’s not just young adults who have gained health insurance as a result of the ACA. From 2010 to 2016, the number of Americans without health insurance fell by 20 million people.  A 2013 University of Minnesota study found that people with mental health problems are disproportionately represented among the uninsured. The ACA’s success in decreasing the uninsured rate means that a significant number of previously uninsured people with mental health problems have been able to obtain health insurance that covers mental health care.

Unfortunately, the uninsured rate has been creeping back up under the Trump Administration, and some of the ACA’s coverage gains had been eroded by 2018.

An estimated 1.2 million people with substance use disorders have gained health coverage as a result of Medicaid expansion under the ACA. This is beneficial not only to the patients, but also to the hospitals and health care providers who care for people with serious mental health issues.

By 2020, up to 32 million people will have gained access for the first time to mental health and addiction treatment coverage as a result of Medicaid expansion. And according to a 2015 Kaiser Family Foundation analysis, Medicaid benefits for behavioral health services tend to be more comprehensive than the benefits provided by private plans available in the ACA exchanges.

Still work to be done

The ACA has dramatically increased coverage for behavioral health treatment. But the National Alliance on Mental Illness published a report in 2015, detailing problems with access to behavioral health providers and limited coverage for some brand-name medications, particularly anti-psychotics. The report also noted that health insurance companies were still more than twice as likely to deny authorization for mental health care, compared with authorization for general medical care.

Although insurance coverage – with behavioral health benefits – is much more widespread than it used to be, access to care is still limited in some circumstances. In many states, there’s a shortage of mental health providers, which is magnified in rural areas. It’s not uncommon to see a two- to three-month wait times when new patients are seeking an appointment with a psychiatrist.

Mental Health America of Eastern Missouri fully supports the expansion of Medicaid in our state.  For more information about this important expansion, you can turn to the Missouri Budget Project, MO Foundation For Health and Cover Missouri