Loopholes in Insurance Barring Mental Health Patients

A flood of patients who have become newly insured under the Affordable Care Act are visiting doctor’s offices and hospitals, causing some health workers to worry about how they can provide care to everyone in need. One group, however, isn’t lining up for care: People with mental health issues or substance use disorders.

Though Obamacare extends coverage to this group – collectively referred to as behavioral health – various loopholes in the health care law at this time have kept people from requesting mental health care. Some states haven’t expanded Medicaid, the government health insurance program for poor or disabled Americans, leaving about 5 million in a coverage gap, the majority of whom, experts believe, need mental health care. In other cases, patients aren’t even aware of the benefits they can get with their new health insurance.

The Congressional Budget Office projected that 13 million uninsured Americans would have access to health coverage by 2014, whether through Medicaid, online exchanges or the private market. But so far the demand for mental health services hasn’t budged, even though provisions in the health law make it more affordable.

More patients seeking mental health care will come within the next few years, experts project, and the question then will be whether there will be enough providers available. Paul Gionfriddo, CEO of Mental Health America, predicts a ” bump in the road where access gets a little more constrained,” though he is optimistic that the details of the law will work the way they are supposed to in time.

“We haven’t been hearing about access issues from our members,” says Stuart Gordon, director of policy and health care reform at the National Association of State Mental Health Program Directors.

That isn’t for lack of need. Mental health is one of the most common health care issues, affecting as many as 1 in 4 adults each year.

The federal Substance Abuse and Mental Health Services Administration found in a 2013 report that 9.6 million adults reported having a serious mental illness, such as major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary