I have a friend named Sarah who is currently seeking mental health care. Despite having insurance, she finds herself on the edge of postpartum depression and regular depression—if such a thing can even be considered regular. Living in a rural area of the South, she faces the daunting task of locating a doctor, knowing that any potential provider will likely be a 40-minute drive away, if she can even find someone who takes her insurance. The reality is that many psychiatrists in her region either don’t accept insurance or aren’t accepting new patients. I genuinely hope she finds a doctor soon—she desperately needs help.
I consider myself fortunate. I pay a significant amount out of pocket for my mental health care, as my psychiatrist doesn’t take insurance either. My medications, while covered by my pharmacist, still cost me over a hundred dollars each month. I can’t help but think about how much worse my situation would be without the Affordable Care Act (ACA, or Obamacare). With multiple mental health diagnoses, affording my medication would have been nearly impossible. I only have access to care because we can pay my psychiatrist directly. Unfortunately, my state opted out of Medicaid expansion, despite President Obama’s attempts to persuade them otherwise.
As the ACA faces repeal, the landscape of mental health care in this country is on the verge of becoming even bleaker. According to Mental Health America, one in five Americans grapples with a mental health condition, which translates to over 40 million individuals—roughly the combined populations of New York and Florida. The ACA increased access to insurance, which in turn improved access to mental health care. Unfortunately, in states that did not expand Medicaid, 19% of individuals remained uninsured, compared to just 13% in states that did. With the repeal, Medicaid expansions could vanish within two years, leading to a dramatic rise in the number of uninsured individuals with mental health conditions.
Currently, 56% of people with mental health conditions lack access to the care they need. The repeal of the ACA is poised to worsen this crisis even further. The Department of Health and Human Services estimates that around 20 million people gained insurance through the ACA, and many insurance policies sold through the ACA were required to offer mental health parity, which covers therapy, medication, and even preventative measures like depression screenings. For instance, my insurance covered a significant portion of my outpatient hospitalization for intensive therapy—a cost we could never have managed without it.
In essence, the ACA was making a difference. The more people who are insured, the more likely they are to seek mental health care. However, if the ACA is repealed, the Congressional Budget Office predicts that 18 million people will lose their insurance in 2018 alone. This number could swell to 27 million in the following year, and reach 32 million by 2026. With one in five of those individuals suffering from a mental health condition, that equates to about 6.4 million people without access to necessary care.
Moreover, the Congressional Budget Office warns that coverage would become less comprehensive, and those with preexisting conditions—like my own struggles with anxiety and depression—may find themselves without coverage. This would mean I’d have to pay for essential medications like Wellbutrin, Klonopin, and lithium entirely out of pocket—an expense I simply couldn’t afford.
One of the ACA’s greatest achievements was not only increasing insurance coverage but also drastically reducing premiums for many individuals. Some users reported their premiums being cut in half, which allowed them to access quality mental health care. However, without the ACA, premiums are projected to rise by 20 to 25% in 2018, and insurance companies may manipulate premiums based on mental health history, making it increasingly difficult for those with mental health conditions to afford care.
A report by the CDC stated that in the first nine months of 2015, 24.4% of adults with serious mental illness had not sought care due to financial constraints. While this number is high, it has decreased since 2012, thanks in part to the ACA. Without it, many more will likely go without the care they need. As of now, Congress has yet to propose a replacement plan. Experts at Health Affairs have warned that the repeal of the ACA could lead to “devastating results.” The absence of Medicaid expansions, premium tax credits, and mandates for preexisting conditions and mental health parity will leave countless individuals without essential mental health services. They will struggle to find doctors, afford consultations, and even purchase necessary medications.
I still consider myself lucky, as my husband’s state health plan provides our coverage, but that doesn’t guarantee mental health parity. I am anxious about the prospect of skyrocketing drug costs and rising premiums. The thought of needing to return to a day clinic terrifies me. The ACA has been a lifeline for many, and with its potential demise, I fear the safety net that supports those of us with mental health challenges is crumbling. When you live with mental illness, that feeling can be particularly dangerous.
For those interested in learning more about pregnancy and home insemination, check out this excellent resource: women’s health pregnancy. For at-home insemination kits, consider visiting Make A Mom, which offers reputable products. And to stay informed on related topics, you can read about mental health and its implications at this blog post.
Summary
The repeal of the ACA threatens to worsen the mental health crisis in the United States by increasing the number of uninsured individuals and reducing access to necessary care. Many who rely on mental health services could face significant challenges, including skyrocketing costs and diminished coverage. As we navigate these changes, it’s crucial to stay informed and advocate for accessible mental health resources.