I have a friend trying to get mental health care right now. She has insurance. She’s just on the border of PPD and regular ol’ depression — if depression can be anything but regular — and she’s asked our mutual OB-GYN for doctor recommendations. Since she lives in the rural South, so anyone she finds will be at least a 40-minute drive away. That is, if she can find someone. She needs someone who takes insurance. Most psychiatrists in this area don’t take it, and if they do, they’re not accepting new patients. I pray she finds a doctor soon. She wants help. She needs help.
I’m lucky. I pay an exorbitant sum of money, out of pocket, for my mental health care. My doctor doesn’t accept insurance either. But my pharmacist sure does, and that cocktail of meds still costs me over a hundred bucks a month. I shudder to think what would have happened if the Affordable Healthcare Act (ACA, or Obamacare) hadn’t been in place when we got our new insurance. I’m diagnosed with multiple mental health conditions. Paying for my medication would have been impossible. I only have access to care at all because we’re able to pay my psychiatrist out of pocket. If we couldn’t, too bad — my state didn’t take the Medicaid expansion, despite President Obama’s pleas.
Now the ACA is being repealed, and mental health care is about to get a hell of a lot worse in this country. One in 5 Americans suffer from a mental health condition, estimates Mental Health America, which is over 40 million Americans or the combined populations of New York and Florida. They point out that when access to insurance increased through the ACA, access to mental health care increased. The ACA reduced the number of Americans without access to mental health care.
But in states that didn’t take the Medicaid expansion, 19% of those people remained uninsured. In states that did accept the Medicaid expansion, only 13% stayed uninsured. As the Senate repeals the ACA, the Medicaid expansions would go away in two years, says the Congressional Budget Office. That sends the number of uninsured with a mental health condition skyrocketing.
Already, 56% of those with a mental health condition lack access to care, according to Mental Health America. The repeal of the ACA will make those numbers even worse. Twenty million people gained insurance through the ACA, estimates the Department of Health and Human Services. Most insurance programs sold through the ACA had to guarantee mental health parity, which included therapy, medication, and preventative measures like depression screening. My insurance company was required to cover my outpatient hospitalization a year and a half ago — a giant chunk of change for two weeks of intensive one-on-one and group therapy. We couldn’t have afforded it otherwise.
Basically, the ACA was working. The more likely people are to be insured, the more likely they are to get mental health care. However, with the ACA repealed, in 2018, 18 million people will become uninsured, found the Congressional Budget Office. Even worse, in the year following the repeal of Medicaid expansion and subsidies the number of uninsured will balloon to 27 million and increasing to 32 million in 2026. If 1 in 5 of those people have a mental health condition, that’s a whopping 6.4 million mentally ill people without access to care.
Plus, the Congressional Budget Office reports that “coverage would be less comprehensive, and people with preexisting conditions may be unable to find coverage.” That would be me, whose preexisting conditions of depression and anxiety would no longer be covered. That means the drugs I need to function, my Wellbutrin, Klonopin, and lithium, would no longer be covered. I’d have to pay for them out of pocket — a cocktail I couldn’t afford.
One of the biggest boons of the ACA, however, along with access to insurance and mandated coverage for preexisting conditions, was the drastically lowered premiums many saw. Some people claimed their premiums were halved, giving them the chance to access quality mental health care. But without the ACA, premiums will go up 20 to 25% in 2018, according to the Congressional Budget Office. Now premiums can only vary based on age, geographic location, and tobacco use. Without the ACA, who knows what insurance companies will do — they could jack premiums for the mentally ill, making it hard for even those with insurance to access adequate care.
In the first nine months of 2015, 24.4% of adults with serious mental illness had not accessed a care provider due to cost, the CDC reported. As high as those numbers are, they’re down from 2012, in part because of the ACA. Without it, many more will go without care. Congress has as yet no plan in place to replace it. Health Affairs says that the repeal of the ACA can have “devastating results.” Without the Medicaid expansions, without the premiums tax credits, and without a mandate for preexisting conditions, or mental health parity, we’re going to see a massive number of people go without needed mental health care. They won’t be able to access doctors. They won’t be able to pay for the doctors they can access, and even if they can see a psychiatrist to obtain needed drugs, they may not be able to pay for them. The ACA is about to go down the tubes. And America’s mental health care is headed right along with it.
I’m still lucky. My husband gets our insurance through the state health plan, so we’ll keep our care. That doesn’t guarantee mental health parity however, and I’m terrified my drug costs will skyrocket. As will our premiums. God forbid I need to go back to the day clinic. The ACA has been amazing for us. Now I feel my safety net crumbling. And when you’re mentally ill, that can be a dangerous feeling to have.