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ObamaCare: ObamaCare's mental health coverage

One of ObamaCare's features not often touted is that mental health coverage is one of the essential benefits. Unfortunately, mental health coverage has all of ObamaCare's other coverage problem, except moreso. About the benefits:

Long-awaited improvements in insurance coverage for mental conditions and addictions are expected to become more widely available this year as a result of two major steps that the Obama administration has taken.

The president’s signature Affordable Care Act includes mental health care and substance abuse treatment among its 10 “essential” benefits, which means plans sold on the public health care exchanges must include coverage.

In addition, rules to fully carry out an older law — the Mental Health Parity and Addiction Equity Act of 2008 — were issued in November, after a long delay. The parity law says that when health insurance plans provide coverage for mental ailments, it must be comparable to coverage for physical ailments. For instance, plans cannot set higher deductibles or charge higher co-payments for mental health visits than for medical visits, and cannot set more restrictive limits on the number of visits allowed.

So far, so good. So, knowing what we know about ObamaCare, what would be the first question to ask?

Right. What about narrow networks? As it turns out, you will be even less likely to be able to "keep your psychiatrist" than you were to "keep your doctor," even assuming you can find one. Billing Advantage:

A recent study found that fewer psychiatrists are accepting health insurance. The study, published by the JAMA Network, was conducted over the course of three year groupings, 2005-2006, 2007-2008 & 2009-2010.

The results were shocking. An incredible 55% of psychiatrists do not accept private insurance, as opposed to 89% of other doctors. Additionally, Medicare and Medicaid coverage accepted at a lower rate by psychiatrists, 55% and 43%, compared to 86% and 73% respectively.

Even though an individual may be insured & mental health services covered, this does not mean there will be a mental health professional, like a psychiatrist, in their area that accepts the insurance they carry. This is a hurdle not yet addressed by the Affordable Care Act.

So, if you're happy with your psychiatrist, and at the same time you're forced to purchase insurance through ObamaCare's mandate, you may be forced to choose between one or the other, if your psychiatrist is out of network. Yay!

Of course, I'm old school, so I'm assuming a psychiatrist is somebody you can actually talk to -- which is why choosing your psychiatrist is so important -- instead of a pill pusher. This actually not triumphalist article in The American Prospect has this throwaway line:

The ACA Can't Fix Our Mental Health Crisis
For example, there’s no medical reason why psychiatrists, once they’ve decided on a particular treatment for a patient, shouldn’t delegate responsibility for refills to a nurse. This notion should make sense to anyone who’s paid a $50 for a routine visit to the psychiatrist, only to exchange small talk for ten minutes and walk out with a prescription.

Notice the assumption that "treatment," by definition, includes "refills." (To be fair -- really! -- the "talking cure" is discussed earlier in the article. But, to the author, it's clearly not the norm.

So why do I get the feeling that mental health coverage (and parity) is going to end up as a gift to Big Pharma?

This is another area -- like health insurance as such, and Medicaid -- where I have almost no experience. So, reader comments are most welcome!

NOTE Why so few psychiatrists in networks? TAP explains again:

Psychiatrists are overwhelmingly concentrated in urban areas, and many operate in solo practice, performing administrative tasks themselves. The stiff competition to get into a psychiatrist’s office, combined with the hassle of filing insurance paperwork, may undermine one of the ACA’s fundamental goals: bringing mental health care to low-income patients.

Single payer, of course, would solve the "the hassle of filing insurance paperwork" by eliminating insurance companies. Can't have that!

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Submitted by cg.eye on

From what I've seen and discussed with others, the ACA requirements are swamping mental health facilities.

Just yesterday on the bus, a commuter I've seen there for years was talking with a friend about spending endless time on the phone for appointments, only to be told there are no therapists available. This is a common story -- Nobody Could Have Predicted that people would use healthcare facilities when their plans allow it.

Note I said 'therapists', not psychiatrists -- the head-docs might be the ones to write scripts, but the Talking Cure's shunted off to social-worker-level professionals. It's all triage, chemically supported triage, but triage nevertheless.

And in my state, because of our mass-murder and suicide prevalence, we're lucky: State law supposedly allocates more resources than other regions.

Submitted by Dromaius on

My nephew in law's shrink said that if he quits his job he'd better take COBRA because she doesn't accept any Exchange plans.

I suggested that maybe it would make sense to buy an Exchange plan and pay out of pocket for her. But I was wrong.

Her rate: $350/session, 2 sessions a week (that half hour thing). She's got him on $800/mo meds (for which likely some less expensive older meds will do). No rate negotiations allowed.

In ways, I think getting the psychiatrist out of mental health might be a good idea. See a psychologist (who would give the patient more talk time) and refer to a primary care physician for the meds.

Anyway, this unintended consequence of Obamacare just might be good, I don't know.

Alexa's picture
Submitted by Alexa on

ridiculous, so I'll drop back by after the family [from out-of-town] gets settled in to further comment.

Great catch, Lambert! Don't know what to think will happen next (with the ACA).

Not sure what the background of the writer is, but I have to wonder what this person is thinking.

The suggestion that one can substitute a "live" mental health counselor (whether a MSW, a clinical psychologist, or a psychiatrist) with a "teleconference or telemedicine" is obscene on its face. Or, certainly, it is in some circumstances--such as the counseling of rape or incest survivors. Or our servicemen and servicewomen diagnosed with PTSD, depression, etc., resulting for serving many tours in war theaters.

And this gem:

"For example, there’s no medical reason why psychiatrists, once they’ve decided on a particular treatment for a patient, shouldn’t delegate responsibility for refills to a nurse.

This notion should make sense to anyone who’s paid a $50 for a routine visit to the psychiatrist, only to exchange small talk for ten minutes and walk out with a prescription."

Will proponents of cost-cutting ACA measures next suggest that we fill our Emergency and/or critical care units with nurses who have no knowledge of, or specialty in, these areas?

Probably, since as I posted last summer, beneficiaries enrolled in Medicaid, and female beneficiaries enrolled in Medicare [under the ACA] will be expected to accept "midwives" as their primary care practitioners. Which I strongly criticized at the time!

Granted, a patient, who is not a mental health professional may not see any pitfalls to this policy. But for cryin' out loud, can this writer be serious?

At the very least, if this practice is adopted, it should be limited to Psychiatric Nurse Practitioners or equivalent Physician Assistants, with a 90-day (or less) mandatory review of the attending psychiatrist.

Or, I know, maybe we can just get the neighborhood kids to set up a "stand" like a lemonade stand of old, in which to dispense psychiatric therapy--like this one:

[Lucy With Psychiatric Stand,]