A friend of mine is currently seeking mental health care. Despite having insurance, she struggles with borderline postpartum depression and general depression. Living in a rural area of the South, the nearest qualified doctor is at least a 40-minute drive away, assuming she can find one accepting new patients and insurance. I hope she finds the support she desperately needs.
In contrast, I pay a hefty amount out of pocket for my mental health treatment, as my psychiatrist doesn’t take insurance either. My medication regimen, which includes several prescriptions, costs me over a hundred dollars each month. The thought of what life would be like without the Affordable Care Act (ACA) is terrifying. With multiple mental health diagnoses, affording my medication would have been impossible without it. My state did not opt for Medicaid expansion, leaving many, like me, without crucial support.
As the ACA faces repeal, the situation for mental health care in this country is poised to deteriorate significantly. Mental Health America estimates that one in five Americans, or over 40 million people, suffer from mental health conditions. The ACA increased access to insurance, which in turn improved access to mental health care—reducing the number of uninsured individuals seeking help. However, in states that did not expand Medicaid, about 19% of individuals with mental health conditions remained uninsured, compared to just 13% in states that did accept the expansion.
The Congressional Budget Office indicates that repealing the ACA would eliminate Medicaid expansions within two years, potentially skyrocketing the number of uninsured individuals with mental health issues. Currently, 56% of those with mental health conditions lack access to care, and the repeal could exacerbate this crisis. Estimates suggest that 20 million individuals gained insurance through the ACA, with most plans mandated to provide mental health parity, covering therapy, medication, and preventive services like depression screenings. I benefited from this requirement when my insurance covered my outpatient hospitalization for intensive therapy, an expense we could not have borne otherwise.
Essentially, the ACA was making a difference. Increased insurance coverage correlates with better access to mental health care. However, according to the Congressional Budget Office, if the ACA is repealed, 18 million people will lose their insurance in 2018 alone. The number of uninsured could swell to 27 million within a year, climbing to 32 million by 2026. If one in five of these individuals has a mental health condition, that equates to approximately 6.4 million people without care.
Furthermore, with the repeal, the coverage for preexisting conditions will likely be diminished, impacting individuals like me—those with anxiety and depression may find it impossible to secure necessary treatment. The medications I rely on could become unaffordable without insurance coverage.
One of the significant advantages of the ACA was the reduction in premiums for many people, allowing access to quality mental health care. However, without the ACA, premiums are projected to increase by 20 to 25% in 2018, with insurance companies possibly raising costs for individuals with mental health conditions, making care even less accessible.
In 2015, the CDC reported that 24.4% of adults with serious mental illness had not sought care due to costs. While this represents a drop from 2012, largely thanks to the ACA, a repeal would likely reverse this progress. The lack of a replacement plan from Congress raises concerns about the devastating impact of the ACA’s repeal. Without Medicaid expansions, premium tax credits, and mandates for preexisting conditions or mental health parity, countless individuals will find themselves unable to access vital care.
For now, I am fortunate as my husband’s state health plan continues to provide us coverage. However, I am anxious about potential increases in my drug costs and premiums. The ACA has been a lifeline for many, including myself, and its repeal feels like watching that safety net disintegrate—a frightening prospect for anyone dealing with mental health challenges.
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Summary
The repeal of the ACA threatens to worsen the mental health crisis in the U.S. by increasing the number of uninsured individuals, particularly among those with mental health conditions. The loss of insurance coverage, reduced access to care, and rising costs pose significant challenges for millions who depend on mental health services.