Can Obamacare’s Mental-Health Provisions Help Stop Tragedies?

A pharmacist pours Truvada pills back into the bottle at Jack's Pharmacy on November 23, 2010 in San Anselmo, California.
National Journal
Clara Ritger
Oct. 15, 2013, 6:56 p.m.

When po­lice killed Miri­am Carey after a car chase that ended at the U.S. Cap­it­ol, it re­ignited a de­bate over how to pre­vent such tra­gedies.

But this time, the con­ver­sa­tion was not about guns (Carey was un­armed). It was over ac­cess to men­tal-health care; and some say Obama­care, un­pop­u­lar as it is, may help.

“After each one of these tra­gedies, every­one talks about im­prov­ing men­tal-health ser­vices in Amer­ica,” said Sen. Debbie Stabenow, D-Mich. “It’s time to fi­nally take ac­tion to do that.”

Lack of in­sur­ance and the high cost of care are the biggest reas­ons men­tal-health pa­tients don’t seek treat­ment, ac­cord­ing to a study re­leased in this month’s Health Af­fairs.

The Af­ford­able Care Act sup­ports in­creased ac­cess to men­tal-health ser­vices, with in­sur­ance cov­er­age through the law’s ex­changes set to be­gin Jan. 1 for those who sign up by Dec. 15. The full im­ple­ment­a­tion of the ACA, ac­cord­ing to a Health and Hu­man Ser­vices re­port, will provide first-time ac­cess to men­tal-health ser­vices for roughly 32.1 mil­lion Amer­ic­ans.

The new health law re­quires all in­sur­ance plans in the ex­changes and in the in­di­vidu­al and small-group mar­kets to treat men­tal-health ser­vices equal with oth­er forms of care when it comes to co-pays and de­duct­ibles. In the past, in­sur­ance com­pan­ies did not cov­er — or re­quired high­er out-of-pock­et costs for — men­tal-health ser­vices. Stabenow pro­posed the par­ity amend­ment, which is now part of the ACA.

“People with men­tal ill­nesses are more likely to have lower in­comes,” said Kath­leen Row­an, a doc­tor­al stu­dent at the Uni­versity of Min­nesota and the primary au­thor of the study pub­lished in Health Af­fairs. “That’s be­cause men­tal ill­ness might be lim­it­ing in terms of the work they are able to do or the hours they are able to work. And so, many people face cost bar­ri­ers in terms of ac­cess to care.”

The law will open the doors to af­ford­able care for many of these in­di­vidu­als, Row­an said, through the sub­sidies on the ex­changes and the ex­pan­sion of Medi­caid.

Stabenow’s com­mu­nic­a­tions dir­ect­or, Cul­len Schwarz, said that had the Navy Yard shoot­er had ac­cess to treat­ment, the out­come could have been dif­fer­ent. He cites stud­ies show­ing that people who go without treat­ment are more likely to com­mit acts of vi­ol­ence.

“It’s not that we’ll al­ways stop these tra­gedies from hap­pen­ing,” Schwarz said, “but we can cer­tainly strengthen men­tal-health ser­vices and re­duce the num­ber.”

The next obstacle, Row­an said, will be wheth­er the scope of ser­vices and the num­ber of doc­tors are able to meet the in­creased de­mand for men­tal-health care.

“You know what our biggest pro­vider of men­tal-health ser­vices is?” asked Dr. Eli­ot Sorel, a clin­ic­al pro­fess­or of psy­chi­atry and be­ha­vi­or­al sci­ences at the George Wash­ing­ton School of Medi­cine and Health Sci­ences. “U.S. jails and pris­ons. That’s the res­ult of us not at­tend­ing to this need.”

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