The Affordable Care Act (ACA), also called Obamacare, has provisions that are supposed to make it easier for Americans to quit smoking, get help battling drug and alcohol addictions, and access mental health treatment.
But to what extent?
A distressed soldier at Fort Hood in Killeen, Texas, killed three people this week before turning the gun on himself. The incident has since gotten people talking about the state of mental healthcare in America.
While the ACA now requires insurers selling plans on the online exchanges to offer substance abuse treatment and “mental health parity,” these changes may not translate into effective or immediate help for everyone. But the experts interviewed for this story believe that the law is a good first step.
The law considers mental health and substance abuse treatment one of the 10 essential elements of a health insurance plan. That means that providers on the exchanges, as well as the states that are expanding Medicaid coverage, must offer these services.
What About 'Parity?'
While mental health “parity” in theory means offering the same coverage a person could get for medical or surgical care, it does not require that any specific treatments be covered. It simply requires that the services that are offered for mental health conditions and substance abuse have the same co-pays and out-of-pocket costs as non-mental health services.
And the ACA only requires that this parity apply to individual and small group plans, so its reach is limited. So far, its impact is unknown and will vary nationwide depending on each state's standards.
But with 26 states and the District of Columbia offering expanded Medicaid services this year, substance abuse treatment has reached 62 million people, a policy analyst with the Substance Abuse and Mental Health Services Administration (SAMHSA) told Healthline.
The extent of services varies from state to state, said David Shillcutt, a public health analyst at SAMHSA. But the result is going to be millions of Americans who were previously unable to receive these services gaining access for the first time.
“Access to coverage may be limited due to a shortage of providers,” Shillcutt said. So SAMHSA is working with mental health providers to make it easier for them to get reimbursed. This means offering assistance on updating information systems required for billing insurers, for example.
Mental Health Is Public Health
Joel Dvoskin, Ph.D. is a clinical psychologist and assistant professor of psychiatry at the University of Arizona who has consulted with state and local governments nationwide about providing mental health services. He told Healthline that he is “very hopeful” that the ACA and the Medicaid expansions are “going to matter a lot” when it comes to getting people help.
“Improving mental health care should lower the risk of violence for the whole world a little bit, not just for those with mental illness, but for those who have an emotional crisis because they're losing their job, in the middle of a divorce, or drinking too much,” he said.
Andrew Sperling is director of federal legislative advocacy for the National Alliance on Mental Illness (NAMI). He told Healthline that expanded access to insurance through the ACA provides “a huge step forward,” particularly when it comes to individual and small group plans.
The ACA also attempts to boost public health and shave dollars off of American health care expenses by making smoking cessation required and available without a co-pay through plans sold on the exchange. That's great news, an official with the American Lung Association (ALA) told Healthline, though not all smoking cessation medications are covered.
“Quitting is an extraordinarily difficult thing to do,” said Erika Sward, assistant vice president for national advocacy at the ALA. “Policymakers need to be making it easier to quit smoking rather than harder.”
She added that she is disappointed most state Medicaid programs do not offer smoking cessation treatments.
Taking Threats Seriously
Sperling and Dvoskin stressed that mentally ill people are no more likely to commit violence than anyone else.
But Sperling said that mental problems can be exacerbated by substance abuse and other factors. He said it is important to identify “first break” psychosis, or factors that reveal the onset of schizophrenia or bipolar disorder. These can include hallucinations, agitation, or delusions, and generally occur between late adolescence and early adulthood.
NAMI is studying ways to treat schizophrenia earlier and more effectively. The project is called Recovery After an Initial Schizophrenia Episode, or RAISE. One of its goals is to reduce the staggering financial impact of the disease on government.
Dvoskin said that the most important thing to remember is to always take a troubled person's threats seriously.
“A lot of people who commit acts [of violence] tell people they are going to do it and it's not taken seriously. That's the single most important lesson to be learned [from the Fort Hood shooting]," he said. "It's easy to identify people in crisis and get them help. Doing that may prevent a mass homicide, but we will never know it.”