The Affordable Care Act (ACA) offered an opportunity to improve healthcare for people with mental illnesses. The Mental Health Parity and Addiction Equity Act, introduced in 2008, were the long-awaited results of the efforts to enhance insurance coverage for mental health and addiction treatment. This federal law was amended by the ACA and was supposed to provide help to millions of Americans. However, this project is hard to implement, and health and social organizations will have to overcome several challenges while adjusting to the new system.
Better Coverage for Mental Health and Substance Use Disorders
According to Beronio, Po, Skopec, & Glied (2013), before the Affordable Care Act, 47.5 million Americans lacked health insurance coverage, and 25% of them suffered from substance use disorders or mental health condition. These numbers seem shocking, but it was the sad truth. After the appearance of regulations build on the Mental Health Parity and Addiction Equity Act the coverage for such people was expanded in three ways: by including this type of illnesses in the Essential Health Benefits; by applying federal parity protections to these illnesses in the individual and small group markets; and by providing more access to quality health care that includes coverage for mental health and substance use disorder services (Beronio et al., 2013).
As for the Essential Health Benefits package, the treatment for mental health and substance use disorders became covered as its part. It means that about 3.9 million people covered prior to the Act in the individual market gained this coverage in addition to the one they had. Also, people with small group plans (1.2 million) received mental health and substance use disorder benefits (Beronio et al., 2013).
Furthermore, new regulations connect federal parity rules to the benefits that are a part of Essential Health Benefits package. The result is that people who gain access to coverage through non-grandfathered plans in the individual and small group markets can rely on mental health and substance use disorder coverage which is comparable to the general medical coverage (Beronio et al., 2013). It means that millions of Americans received additional benefits and more confidence about the opportunities of their healthcare coverage.
Finally, the ACA expanded insurance coverage through access to private health insurance in the Marketplaces and Medicaid. The services included in those types of coverage correspond to all federal requirements, so they are of the high-quality. In addition, “the law will also prohibit health insurance companies from denying coverage to people with preexisting conditions” (Mechanic, 2012, p. 377). Hence, in general, the Affordable Care Act gave federal parity protections to 62 million Americans, and this number outperformed the initial number of uninsured citizens.
Redesigning Payment Arrangements
The implementation of new regulations required certain payment reform that would cut down exaggerated costs on care that were typical of the previous pattern of care. According to Mechanic (2012), the care used to be episodic, and the ACA required continuous fixed payments of adjusted capitation and the related use of bundled payments. “Bundled or episode payments use a single payment for a package of services as an incentive for health providers to take greater responsibility for longer episodes of care” (Mechanic, 2012, p. 378). Thus, the reform was necessary to use those payment models for people with long-term disabilities, such as mental health issues and substance abuse.
Moreover, Mechanic (2012) admits that successful redesign is possible because of “the substantial commitment of CMS and its Innovation Center” (p. 378). They developed the scheme of stable organizational work and consistent payment incentives. Besides, the ACA changed Medicaid programs so that they offer a federally funded health home option. It means that states can pay compensations for a health home provider created for a certain patient with mental health problems, and better coordinate the service providers. This change improved the range of services available and general quality of care.
Main Challenges
Colleen and Haiden (2011) state that although the ACA raised expectations concerning the improvement of access and reduce of fragmentation for people with mental health or addiction disorders, numerous challenges remain. Some groups, like undocumented immigrants or people with employer-sponsored plans, will still feel the lack of access to behavioral health coverage even after the implementation of the ACA. Colleen and Haiden (2011) also suggest that states will be eager to reduce financing of mental health services because of the lower number of uninsured people. However, some funding for the remaining uninsured people and assertive community treatment service is essential as it will help to maintain the well-being of people who need it, but cannot afford it.
Besides, the ACA regulations should particularly consider groups at high risk which consist of people with severe mental diseases. They need an appropriate care coverage that will include the possibility of often hospitalizations, homelessness, and treatment nonadherence. Thus, the coverage for them is to be expanded.
To sum up, the Affordable Care Act brought a significant improvement in the field of care after mentally ill people. The states face many fiscal and organizational challenges, connected with the reform. However, the general change of behavioral healthcare is supposed to be improved and to give access to the coverage for millions of people with the mental health condition and substance abuse disorders.
References
Beronio, K., Po, R., Skopec, L., & Glied, S. (2013). Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans. Report prepared for ASPE at the Department of Health and Human Services, Washington, USA.
Colleen, L. B., & Haiden A. H. (2011). Moving beyond parity – Mental health and addiction care under the ACA. The New England Journal of Medicine, 365(11), 973-975. Web.
Mechanic, D. (2012). Seizing opportunities under the Affordable Care Act for
transforming the mental and behavioral health system. Health Affairs, 31(2), 376-382. Web.