Patient Protection and Affordable Care Act (Obamacare)

white houseThe Patient Protection and Affordable Care Act (PPACA), commonly called “Obamacare” or simply the “Affordable Care Act” is a large piece of legislation designed to make health care more affordable and accessible in the United States. Certain provisions of the law began taking effect in 2010, and the law was enacted in full in 2014, making it possible for millions of Americans without health care to become insured.

General Provisions of PPACA

One of the most significant facets of the legislation is the requirement that employers with more than 50 employees provide health care coverage to their employees. This coverage must pay for 60% of medical expenses and should not cost more than 9.5% of family income; employers who do not provide health care or whose health care plans do not meet these standards are subject to fines.

For people who cannot access health care through their employers, a health care exchange provides access to lower-cost health care. This exchange is generally run by the states; however, some states, such as Georgia, opted out of the health care exchange, and the exchange was then set up by the federal government.

Another important shift introduced by the PPACA included the advent of free preventative care. This coverage includes most wellness screenings, such as Pap smears and well-child visits. Once this provision went into effect, insurance companies were no longer able to charge copays for wellness checkups.

The law also put many new consumer protections into place. For example, insurance companies who in the past might have used errors or technical mistakes to deny coverage to customers can no longer do so. Lifetime limits on insurance coverage also increased with the introduction of the PPACA.

Other noteworthy changes in the legislation include:

  • Expanded Medicaid eligibility to any family whose income is 133% or less of the federal poverty level.
  • Provision of prescription drug discounts and monetary relief to seniors who reach the Medicare coverage gap known as the “donut hole.”
  • The offer of subsidies to small businesses to help them purchase health insurance through federal or state exchanges.
  • The offer of subsidies to families that have an income below 400% of the federal poverty level.
  • Requirements that insurance companies offer the same rates to people with preexisting conditions and no longer deny coverage to people based upon these conditions.

Affordable Care Act and Mental Health

Several elements of the Affordable Care Act affected mental health care as well, and proponents of the act anticipated that it would ultimately make mental health care more accessible and affordable. Of particular note was the end of preexisting condition denials. Prior to the PPACA, people with mental health conditions were routinely denied health care, forced to pay more expensive premiums, or denied coverage for prescription medications. Beginning in 2008, insurance companies could no longer set higher deductibles or charge higher copayments for mental health care.

Another aspect of the PPACA that will likely have a significant impact on mental health services was the extension of coverage to young adults: Young adults can now remain on a parent’s plan until age 26. Research shows that 75% of all mental health conditions and substance abuse begins before the age of 24. The extension for young people may provide treatment to many whose conditions may have gone untreated in the past.

As of January 1, 2014, mental health care and substance abuse treatment are listed among the “Ten Essential Benefits,” joining laboratory work, emergency room care, and maternity care, among others, as services for which health insurance companies are required to provide coverage. The new law also emphasizes preventative services such as screenings for mental health issues in adults and behavioral assessments for children, and it incentivizes doctors and hospitals to provide these services. Thus, people with mental health conditions might be diagnosed earlier or receive more comprehensive treatment for their conditions. The plan hopes to increase preventative care and early treatment of all health conditions, whether physical or mental.

However, because states are allowed to opt out of the law’s expansion of Medicaid, Americans with mental health conditions who live in these states and cannot afford other insurance may still find themselves lacking coverage. Additionally, the states that have chosen to set up their own health exchange marketplaces instead of using the federally facilitated exchange were able to decide essential benefits on their own, and many of these states have provided only minimal mental health benefits.

Critics also point out that ongoing coverage is not guaranteed for certain conditions. It also does not provide for coverage of some services that might be necessary in the treatment of a mental health condition, such as residential housing. What’s more, as an increasing number of Americans begin to seek mental health care services and treatment, mental health care providers, who are already in short supply to meet demand, will be needed in greater numbers.

References:

  1. Braverman, B. (2013, November 26). 6 Ways Obamacare Is Changing Mental Health Coverage. Retrieved from http://www.thefiscaltimes.com/Articles/2013/11/26/6-Ways-Obamacare-Changing-Mental-Health-Coverage.
  2. Brink, S. (2014, April 29). Mental Health Now Covered Under ACA, but Not for Everyone. Retrieved from http://www.usnews.com/news/articles/2014/04/29/mental-health-now-covered-under-aca-but-not-for-everyone?page=2.
  3. Key features of the law. (n.d.). Retrieved from http://www.healthcare.gov/law/features/index.html.
  4. Miller, A. (2015, January 26). Obamacare has been a huge help for mental health care. Retrieved from http://www.cnbc.com/id/102369652.
  5. The Affordable Care Act and mental health: An update. (n.d.). Retrieved from http://www.healthcare.gov/blog/2010/08/mentalhealthupdate.html.

Last Updated: 08-17-2015

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  • Catherine Boyer, MA, LCSW

    Catherine Boyer, MA, LCSW

    December 13th, 2012 at 4:43 AM

    Thanks for the summary. It’s how I understood it, but it’s helpful to have an easy to understand document to give to people who have questions. There’s a great deal of – in my opinion unwarranted – anxiety about the changes, which I think are positive ones.

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