The Affordable Care Act (ACA) is facing repeal, and this decision could exacerbate the ongoing mental health crisis in the United States. A friend of mine, Sarah, is currently struggling to access mental health care despite having insurance. She finds herself teetering between postpartum depression and general depression—if one could even categorize depression as “regular”—and is actively seeking recommendations from her OB-GYN. Living in a rural area of the South, she faces the challenge of finding a psychiatrist who accepts her insurance, with potential providers often located over 40 minutes away, if she can find one at all. Unfortunately, many psychiatrists in her region do not accept insurance, and those who do are frequently not taking on new patients. I sincerely hope she locates the help she desperately needs.
In contrast, I consider myself fortunate. I pay a significant amount out of pocket for my mental health care, as my psychiatrist does not accept insurance either. However, my pharmacist does accept it, and the monthly cost for my medication still exceeds a hundred dollars. I shudder at the thought of what I would do if the ACA had not been in place when we acquired our new insurance. With multiple mental health diagnoses, affording my medication would have been an impossibility. My access to care is solely due to our ability to pay out of pocket for my psychiatrist. If that option were unavailable, I would be out of luck, particularly since my state opted out of Medicaid expansion despite former President Obama’s appeals.
The repeal of the ACA threatens to worsen the state of mental health care across the nation. Mental Health America estimates that one in five Americans suffers from a mental health condition, which translates to over 40 million individuals—comparable to the combined populations of New York and Florida. The ACA significantly increased access to mental health care by reducing the number of uninsured Americans. In states that expanded Medicaid, only 13% of individuals remained uninsured, compared to 19% in states that did not. The Congressional Budget Office projects that repealing the ACA will eliminate Medicaid expansions within two years, resulting in a dramatic rise in the number of uninsured individuals with mental health conditions.
Currently, 56% of people with mental health issues lack access to necessary care, and the ACA’s repeal will further deteriorate these statistics. The Department of Health and Human Services estimated that 20 million people gained insurance through the ACA, many of which included provisions for mental health parity—mandating coverage for therapy, medication, and preventive measures such as depression screenings. My insurance was required to cover my outpatient hospitalization for intensive therapy, a service we would not have been able to afford otherwise.
The ACA has proven effective in increasing insurance coverage, which correlates with improved access to mental health care. However, the Congressional Budget Office forecasts that 18 million people will lose their insurance in 2018 alone. Following the repeal of Medicaid expansion and subsidies, the uninsured population is expected to swell to 27 million, potentially reaching 32 million by 2026. If one in five of these individuals has a mental health condition, that equates to an alarming 6.4 million people without access to care.
Furthermore, the Congressional Budget Office indicates that coverage will likely be less comprehensive, leaving individuals with preexisting conditions—like my own depression and anxiety—vulnerable to losing their coverage altogether. This would mean that essential medications such as Wellbutrin, Klonopin, and lithium might no longer be covered, forcing me to pay for them entirely out of pocket—a financial burden I could not sustain.
One of the significant advantages of the ACA was the reduction of premiums for many, with some individuals reporting a decrease of nearly 50%. Without the ACA, premiums are projected to rise by 20 to 25% in 2018, and insurance companies could increase premiums for individuals with mental health conditions, further complicating care access for those already insured.
According to the CDC, in the first nine months of 2015, 24.4% of adults with serious mental illness did not seek care due to cost—a figure that has likely risen since. While these statistics have improved since 2012 due to the ACA, the repeal will likely reverse this trend. Health Affairs warns that repealing the ACA could lead to “devastating results,” leaving countless individuals without access to essential mental health care and hindering their ability to afford necessary treatments. As I watch the ACA’s safety net unravel, I’m filled with trepidation about the future of mental health care in America.
While I remain fortunate that my husband’s state health plan provides our insurance, there are no guarantees regarding mental health parity. I fear that our drug costs and premiums will surge, and the anxiety of potentially needing to return to a day clinic feels overwhelming. The ACA has been a lifeline for many, and its repeal puts that support at significant risk.
In summary, the repeal of the ACA stands to greatly worsen the mental health crisis in the United States, leaving millions without access to necessary care and medications, particularly for those with preexisting conditions. As the safety net provided by the ACA frays, individuals like Sarah and myself may find our mental health needs unmet, raising serious concerns about the implications for public health.
Keyphrase: Mental health care access
Tags: home insemination kit, home insemination syringe, self insemination