Attitudes and understanding of mental health care issues are changing in the United States, in part due to the Affordable Care Act (ACA). Moving into its second year, we are seeing a shift in utilization and accessibility to behavioral services that benefit millions of Americans and can save millions of dollars. For those involved in delivering this care and to an estimated one in 17 Americans facing a serious mental health illness, this is welcome news and one that was overdue.
Granted, we have more to do — and the political evaluations of the ACA and some macro- and micro-economic considerations of the law will continue to be debated. I was among the many closely following the law, but from the lens of those providing mental health-care services, it has had a measurable positive impact for people in need despite issues with the rollout and some bumps last year. Support for the law continues to waiver around fifty percent, but many of the key provisions that have strong support and popularity are linked to behavioral health.
For too long, mental health care was in the shadows and coverage was inconsistent, despite the fact that about 50 percent of Americans experience a mental health episode during their lifetime, from depression or anxiety to chemical dependency or schizophrenia. The ACA changed that imbalance in coverage by putting mental health and substance abuse benefits on par with medical and surgical benefits. By law, coverage for cancer treatment would be the same for substance-abuse treatment. In addition, there would be no lifetime or yearly dollar limits for mental health care – recognition that services and recovery can take time and be expensive for patients and families.
This year, an estimated 3.7 million Americans with significant mental illnesses now have coverage and access to care through the insurance exchanges or extended Medicaid — they have moved from the shadows and into needed treatment.
But other well-known provisions of the ACA translate into mental health-related benefits. Given that teens and young adults encounter higher levels of behavioral issues (half of all mental health and substance abuse begins before high school and 75 percent develop before age 24), the under-26 provision allowing parents on their policies to continue providing coverage to their underage children has extended coverage to an at-risk population. Considering the cost of untreated mental illnesses on individuals, families and society, providing care to young adults will not only improve the quality and productiveness of lives but also save money.
According to the University of Minnesota's School of Public Health, the first-year impact of the ACA on younger adults is encouraging: Inpatient mental health care has increased while emergency room psychiatric care has dropped. Younger patients are getting services where and when they need it – rather than waiting for a crisis and visiting an ER. This improves the quality and delivery of care while reducing costs of treatment.
The pre-existing condition coverage includes mental health and substance abuse. What was frequently seen as a benefit for diabetics, heart disease or cancer survivors also includes individuals with behavioral health issues. The prospects of losing insurance was a barrier for people recovering — how could a patient move to a new job or new community and the next stage of their recovery if they faced the prospects of losing their insurance due to pre-existing conditions? That has been fixed.
While more than eight million Americans now have private health-care coverage through the ACA, an estimated 41 million still lack coverage — that includes nearly four million low-income Americans suffering from serious mental illnesses who live in one of 24 states that did not expand their Medicaid programs. People at or near the poverty line suffer from higher instances of mental anxiety and disorders. We need to recognize these risk factors and treat them accordingly.
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A hallmark of the new law is the extension of coverage for mental health; it will be seen as a turning point in care for years to come. It now comes down to further implementation and expansion of coverage to at-risk populations, increasing the number of caregivers and options for treatment, and encouraging continued advances in medicines and treatments. And as a society, we must seek to understand and support our loved ones and others that face mental health issues recognizing that access to care benefits us all.
Commentary by Alan B. Miller, CEO and chairman of of Universal Health Services, which employs more than 68,000 people at 225 health-care facilities, including 25 acute-care hospitals, 195 behavioral health facilities and three surgery centers across the United States.