Obamacare actually delivering some hope

heart2 By: LaurieeG

To say Obamacare has gotten off to a rocky start would be an understatement. Obamacare, who’s official title is the Affordable Care Act, has been plagued with a motley collection of complications since its rollout on October 1st of this year. Still, for all the ways Obamacare continues to disappoint conservatives like Senator Ted Cruz (R-TX), there is some excitement sprouting in the mental healthcare sector. As of November the administration has made effective new regulations regarding insurance coverage for mental health and substance abuse benefits.

The new regulations are part of a legislation that began taking shape over two decades ago – the Mental Health Parity Law. The new law requires insurance companies to treat and cover mental disorders and addiction problems the same as physical ailments. Companies previously could place restrictions on mental health treatments such as maxing individual therapy sessions out after twelve visits or only allowing psychiatric visits once every three months. This gap, created by the untouched and/or ineffective government legislation and insurers, often left individuals in need of mental assistance waiting or worse spiraling out of control. A 2005-06 survey conducted by a Los Angeles, California psychiatrist found that on average the waiting period for a patient in need of mental health care was five weeks; fast forward six years and little has changed. That is a seemingly endless time when you are suffering from insomnia or feeling the paranoia of a world out to get you. Mental disorders left untreated can lead to tragic events like suicide or violent rampages that wound others.

According to the National Institute of Mental Health (NIMH) approximately 26.2 percent of adults in America will suffer from a “diagnosable mental disorder” in a single year; of these almost half will be affected by 2 or more disorders at one time. This is equal to about one individual out of every four people. If you apply that information to our class, around two and a half of us are currently impacted by a mental disorder.

The term mental disorder, or illness, is commonly defined as a condition that can lead to serious disruptions in a person’s thinking and/or behavior. It is a generalized term that refers to a variety of disorders – not just those widely known like Depression or Schizophrenia. For example Autism also falls into this category. Mental illness is an equal opportunist. It affects all genders, all age groups and all races without discrimination. There is no pre-set limit for how long it will impact an individual. It can last a lifetime like Diabetes or as little as a few days like the flu. The one aspect that unites each and every mental disorder is their necessity for medical treatment. Yet, in America, treatment has often been restricted due to stigmas that lead to limited coverage by insurance companies and a lack of mental healthcare providers. 

Mental Health has been a societal concern for centuries. The Greeks believed mental disorders were a sign that a person was either cursed by the gods or receiving a divine message. This idea is similar to those found in Biblical stories such as in Saul and David (I Kings) or with Jesus and any person possessed by a demon. In Medieval times mental illness became a marker of witchcraft. And, even later on, after the discoveries of doctors like Phillippe Pinel or Carl Jung, people with mental disorders continued to be isolated due to a lack of understanding. While mental illness may just be in that person’s imagination it does not mean that what she/he is experiencing isn’t real. The debilitating effects of a Bipolar disorder are as equally damaging as a broken limb; both can lead to death if not properly treated. So which one should we save?

If you review the history books you will find the clear winner. Until as late as the 1960s only one was associated with survival; the other was cast into an asylum – also characterized as being hospitalized or institutionalized. The first sign that mental health should be a national concern in America came at the end of the 1940s when the National Institute of Mental Health (NIMH) was established. Since its creation the NIMH has been a primary research community for studying the brain, the mind, and human behaviors. Unfortunately this has not meant better care or wider understanding for the illnesses in our communities. Data shows that in mid-1950s 560,000 people were institutionalized for mental disorders. It takes roughly another twenty years before this number is cut in half, and not for lack of trying.

After the NIMH’s establishment the first big legislature to show concern for mental disorders on a national level was the Community Mental Health Act (CMHA) sign into law by President Kennedy before his death in 1963. It was passed in order to help fund community-based centers that focused on mental health and awareness as well as put an end to institutionalization. Regrettably it has only been a partial success due to governmental budget cuts and reorganizations. The most recent resurgence concerning mental health at a national level began in the early 1990s. According to President George Bush it was the “decade of the brain”.  Research continued and, in 1996, the government made their first attempt to offer better medical assistance.

September of 1996 brought the passing of the Mental Health Parity Act (MHPA). The act offered companies the chance to offer insurance coverage for individuals with mental disorders. However those who did so had the right to restrict the number of visits and days of inpatient care.  The problem with these types of limitations is that treatment of a mental disorder can’t be based on time frames; just because a person has gone to all 12 visits doesn’t mean he/she is fixed. It would be like taking the training wheels off a child’s bike before he/she was steady. The child will likely get up after he/she falls over but someone with a mental illness might not. Furthermore the MHPA did not cite chemical dependency or substance abuse as part of the allowable coverage. This left individuals who could benefit from medical treatment to suffer. Groups such as AA and NA can only do so much. With long-term, continual use of certain substances the body will have physical reactions that require a medical professional’s intervention. Twelve steps just aren’t enough for some; addiction is a lifelong struggle.

It only took six extensions and twelve additional years for the government to realize that the legislature wasn’t that effective. On top of limiting visits, some insurers had found other ways to legally dodge the act by increasing costs where possible. Thus in October 2008 the MHPA was expanded in an attempt to fill in the gaps. The act became known as the Mental Health Parity and Addiction Equity Act (MHPAEA).    But, alas, the new act failed to make mental health and addiction treatment coverage mandatory. These benefits continued to fall into the “carve-out” categories with others like dental, eye care, and surgical. Individuals without coverage in need of this type of assistance would have to pay out-of-pocket. Healthcare cost for mental disorders is one of the top five most expensive medical conditions. Perhaps the top reason that some individuals do not seek help is because of their inability to pay costs. So what does it cost? Double or quadruple what you pay for a full tank of gas and you’re at about the average price for one therapeutic session. Now image if you had to come up with that amount every one to three weeks as well as any additional costs for medications. Which do you choose: rent or remedy?

As of Friday, November 8 individuals with mental disorders and/or addiction problems who need medical treatment will no longer have to make that choice. Obamacare, or the Affordable Care Act, has now made these benefits a coverage requirement. Moreover previous restrictions such as visit limitations and price gouging will no longer be allowed. Our minds can now receive the same concern and treatment as our bodies. Finally there may be a chance to be both healthy and happy at once.

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