ACA Replacement and What it Could Mean for Behavioral Health Access and Coverage

Mar 1st, 2017

By: Stuart Archer, CEO, Oceans Healthcare

The topic of Affordable Care Act repeal and replace has been at or near the top of the news since President Donald Trump took the oath of office in January. Speculation has abounded about what that might mean for millions of Americans and just how long it might take. 

Last Friday we saw a minor, albeit unconfirmed, glimpse of what congressional House Republicans could be eyeing as a replacement when a first draft of new legislation was leaked

While I understand draft legislation does not equal a final bill, as the leader of a seniors-focused behavioral health company, I am concerned about provisions in the draft that could have a far-reaching impact on behavioral health and our citizens’ ability to access treatment, including: 

  • Potential repeal of the ACA’s requirements for what health insurance must cover. According to reports, the draft legislation could repeal the ACA’s essential health benefits requirement, which mandates that health plans cover 10 categories of services including mental health and substance abuse treatment. While our industry recently celebrated a victory with passage of the 21st Century Cures Act, repealing the requirement to cover these services could be devastating for individuals managing a mental health issue or substance abuse disorder.
  • Increasing premiums for individuals who let coverage lapse. The draft legislation proposes that insurers could increase premiums by 30 percent for individuals who sign up for a health plan after letting prior coverage lapse. This is an effort to encourage individuals to keep coverage even as the legislation removes the individual mandate. For many with severe mental illness it can be difficult to maintain steady employment, and in turn, consistent health insurance coverage. An increase of such magnitude will put health insurance out of reach for many with chronic mental illness – and could have a significant and negative ripple effect throughout our communities.
  • Raising premiums on older adults at a rate five times greater than that of young ones. The draft legislation would now allow insurers to charge older customers up to five times as much as their younger counterparts. Right now, they can charge only three times as much. And while the argument is often true that older adults require more care, an increased cost to older individuals and seniors who are potentially living on a  fixed income, or very little income, could mean the difference between someone receiving the care they need or delaying until they’re forced to seek treatment in an emergency room setting. 

At one point or another, most every human being will be directly or indirectly impacted by behavioral health challenges.  Today, more than one in five adults suffers from a mental disorder, with even higher rates among aging adults.

As the largest provider of behavioral health services for seniors in Louisiana and one of the largest in Texas, we understand firsthand the impact inadequate coverage and access can have on a patient – as well as their children, grandchildren, caregivers, neighbors, etc. I remain cautiously optimistic that when our nation’s congressional leaders take a vote on the final legislation and take action on the ACA, they will think of the millions of Americans and their families who continue to struggle with this often stigmatized illness.  

Stuart Archer, CEO of behavioral health provider Oceans Healthcare, is also an at-large board member of the National Association of Psychiatric Health Systems.



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