The tragedy of the Sandy Hook school shootings made gun control a national topic once again. It also put mental health issues in the spotlight. With all the controversy surrounding Obamacare, one positive outcome will be increased access for mental health insurance coverage for millions of Americans who don’t have coverage. In addition, the 30 million or so who already have some level of mental health coverage could see improvement to their benefits.
According to an article in the New York Times, mental health insurance is part of the “essential health benefits” mandated in the Affordable Care act. In fact, the article states that 32 million Americans could gain access to these benefits. Mental health coverage would cover mental illness, behavior disorders, drug and alcohol addiction and other mental health conditions.
This is a major change for those who previously had access to health insurance. About 20 percent of health insurance policies did not include coverage for mental illness. A higher percentage excluded treatment for substance abuse.
The standardization of health insurance benefits is controversial. But what Obamacare may do is level the playing field for those who need these services. It may make it easier for employees and individuals to choose between health care plans whose benefits, deductibles and copays varied widely. Since plans will have to offer the same basic level of coverage, there will be less confusion or fear of losing needed benefits by choosing the wrong plan.
Who pays for coverage—the individual or insurance company—is still unsettled. Insurers can offer health plans at four levels. The least generous plan calls for the individual to pay 40 percent and the insurer will pay the rest. At the other end of the scale, individuals will pay only 10 percent of the cost and the insurer pays the rest. Instead of a national standard, states will be able to define the plans and set requirements.
With states able to set their own requirements, access to prescription drugs could vary widely. Many patients with mental health issues may take a number of prescription drugs. Without a national standard, the article states, patients in one state may have access to many more prescription drugs than in another state.
On a positive note, the ACA will hold the line on deductibles for individuals in the small- to middle-range group market to $2,000 for individuals and $4,000 for families. This cap on deductibles lowers the obligation of individuals to satisfy a deductible before the insurance company pays the entire bill for healthcare. The ACA will also limit out-of-pocket maximums. Lowering these limits will put more money in the pockets of those paying the high price of health insurance.
There are many people suffering from mental illness, substance or alcohol abuse, behavioral disorders and depression who are able to function in life and work. As their co-worker or manager, you may not even be aware of the struggle they have every day. Without health care and insurance coverage for mental health issues, these conditions can continue and eventually affect not only the individual but their families, co-workers and companies. The ACA will make these services available and more affordable for those who need them the most.
Photo Source: Freedigitalphotos.net
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