The Affordable Care Act

by Catherine Boutwell

As you probably aware, this past week the U.S. Supreme Court is hearing arguments on whether the Affordable Care Act (ACA) is constitutional. The ACA is part and parcel of the Health Care and Education Reconciliation Act 2010. The two most integral components of the act also happen to be the most controversial: If passed, the ACA would require individuals to purchase health insurance and states would be required to expand Medicaid services to those at or below 133 percent of the Federal Poverty Level (FPL). While I am hesitant to begin a debate about the constitutionality of mandating individuals and expanding Medicaid, I do think that if ACA is implemented, there are serious implications for mental health care.

An overwhelming number of individuals suffering from a mental illness also live in poverty. In 2005, the National Alliance of Mental illness (NAMI) reported that Medicaid provided the 50% of mental health services in the United States. Moreover, there are approximately 6.6 million who receive Supplemental Security Income (SSI). For those under the age of 65, close to 3.8 million are eligible for assistance and of that, more than half are estimated, about 2.8 million, to be adults with severe mental illnesses. These numbers exclude ineligible individuals still in need of assistance. 

Most often, a person who receives SSI will also meet the standard to receive Medicaid. However, there are a good number states in which require a separate application for medicaid and apply more stringent eligibility rules. Data from 2005-2006, released by National Survey on Drug Use and Health shows that one-third of the mentally ill are within federal poverty level remain uninsured. These individuals may not be covered to due illegal immigrant status, extremely low functioning, or their illnesses are not considered severe enough. 

If there were to be an expansion of Medicaid, as requested by the ACA, millions of mentally ill Americans who do not currently qualify for bogus reasons such as pending SSI applications, an income that slightly exceeds eligibility and those who do not have a permanent address will be more likely to receive aid. The ACA also requires insurance policies to cover mental health treatment, including substance abuse, as they do medical conditions. Importantly pre-existing conditions will no longer  be used as a means to exclude individuals from coverage. Moreover, the mentally ill will be included among other groups to apply for federally subsidized insurance within their state. 

While there may be a number of flaws with Obama's reform, it does acknowledge the needs of a growing mentally ill population and how strongly related mental illness is to poverty and access to care.

An overview of the Health Care Reform Act al la CBS.