Attacks on ACA Is An Attack on Mental Health


Health Editor’s Note: Some of the rights/conditions of the Affordable Care Act (ACA) was that it did away with a  pre-existing condition as a reason why someone could not have access to health insurance.  If one were to closely look at the health records of Americans, most will have had a pre-existing condition which would have locked them out of getting affordable health care.  An unnecessary and deadly Catch 22 for a person’s health and also for  his or her pocket book.  Another huge plus for Americans is  that the ACA provided accessibility to mental health care and substance abuse care. Two areas that intensely hit the American population, especially with the current ongoing opioid crisis. Those with mental health conditions have been historically greatly under served. Let us not move backward in treating those with mental health and substance abuse conditions…..Carol 

Attacking the ACA Is an Attack on Mental Health: The Sequel

The threat is even more real

By Michael Friedman LMSW MedPage Today

This article is adapted from a blog post on Sept. 20, 2018, when the author anticipated the consequences of a possible federal court ruling declaring the unconstitutionality of the Affordable Care Act.

The Affordable Care Act (a.k.a. Obamacare) was ruled unconstitutional by a federal court in Texas in December. That ruling has been appealed, and now the Justice Department has asked that the ruling be upheld. If that happens, millions of people will lose health coverage, including coverage for mental health and substance abuse treatment.


The Affordable Care Act increased access for these services for those tens of millions by increasing coverage generally, by mandating that the health coverage purchased through the federal and state health exchanges include coverage for mental health and substance abuse treatment, and by requiring coverage of pre-existing conditions — including mental disorders. It also required parity — i.e., that payment for behavioral health services be on a par with physical health services, making such services more affordable.

Before the Affordable Care Act, many health insurance plans for small groups or individuals and occasionally for large groups did not cover behavioral cost at all or only at a great additional cost. The amount of coverage was also usually very limited. Typically, there were caps on numbers of covered outpatient visits and of inpatient days per year. Co-pays were typically 50% rather than 20%. Annual and lifetime caps were common, which might not be a problem for occasional acute disorders but left people with chronic conditions without coverage very quickly.

Mental and substance use disorders were also among the pre-existing conditions for which coverage could be and often was denied.

Federal legislation prior to the Affordable Care Act addressed some of the problems related to lack of parity, but not all. And parity was only required if a health plan included behavioral health coverage, not if the health plan covered only physical health conditions — a widely used option open to the purchasers of health plans.

And, prior to the ACA, no one — not large employers or small employers or individuals — was legally obliged to buy health insurance at all.

The ACA addressed all of these problems. Employers — except very small employers — were required to provide coverage for their employees (some with subsidies). Medicaid eligibility was extended to more working poor people. Individuals who did not have coverage through work, Medicare, Medicaid, the State Child Health Insurance Program, or the VA were required to purchase coverage (some with subsidies). And the small group and individual plans purchased through the federal or state health exchanges were required to include coverage for mental health and substance abuse disorders.

The original expectation was that changes under the ACA would provide behavioral health coverage for as many as 62 million people. The decision of several states not to extend Medicaid to larger populations and a subsequent decision not to penalize people who did not purchase insurance resulted in some shortfall. Nevertheless, there are still tens of millions of people with behavioral health coverage today who did not have it prior to the ACA.

Of course, not all will lose coverage if the ACA falls. Some employers who previously did not provide behavioral health coverage may decide to do so. Some individuals could continue to buy plans with such coverage — if such plans are affordable.

But that is unlikely. If people who do not believe they need coverage for mental health or substance abuse services opt for cheaper plans without behavioral health coverage — or no plans — the cost of plans with such coverage will rise because the people who buy them are likely to use them. The insurance industry refers to this as “adverse selection.”

If our nation really wants to have a health insurance system that will help to address the opioid epidemic and the vast underservice of people with mental disorders, it must make sure that behavioral health coverage is affordable. It must also require coverage of people with pre-existing conditions. And it must enforce parity requirements.

To do this, the Affordable Care Act must stay in place unless or until a viable alternative is created. Swatting it down suddenly by court decree will have devastating consequences for millions.

Michael B. Friedman, LMSW, is an adjunct associate professor at the Columbia University School of Social Work in New York City.

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  1. Yes Ian, health is a very important topic. I won’t blow away but will continue to address the science that free speech allows me. If you ever want to talk medical science instead of resorting to Ad hominem attacks then look me up. Usually people are more upset by the truth than BS. You might actually read more and bellow less then you might not need to take so many drugs that you say you take. Seriously, stress kills, truth heals. Best to you and your health, and I mean it!

    • Don’t insult us by claiming you have the first idea about ‘medical science’ as clearly, you haven’t got a clue. How else do you suggest the doctors treat the infections I was hospitalised by than With antibiotics? There is no other treatment and without those antibiotics, the only thing they could do is amputate my legs and pray and cross their fingers that the infection had confined itself to my legs ad hadn’t spread into my blood and then into other parts of my body. Or what about the fact that my body doesn’t produce some of the key hormones and therefore I have to take synthetic hormones, there is no other treatment for that ailment, the condition is a genetic defect I was born with. Therefore I know for a fact that I wouldn’t be alive today without the use of pharmaceutical products. But no, you know better and issue utterly stupid statements about healthcare being better without pharma…. You’re an idiot and when you spout off your idiocy on important subjects that are matters of life and death then you deserve nothing but scorn and contempt.

  2. Ian, You sound like a seven year old with your potty mouth. Sorry if my comments are causing your Merck shares to drop.

    • I have almost no tolerance for people that talk utter nonsense, especially when it is about something so serious as healthcare. You should be ashamed of yourself for the crap you spew. I am only alive today due to pharmaceuticals which I have to take on a daily basis. I have had several hospital stays in the last two years, where only thanks to antibiotics, have I survived. Therefore, when I read bullshit like you write, it deeply offends and annoys me and being from the North of England, where we are (in)famously blunt and to the point, I don’t hold back in speaking my mind, especially about such important topics as healthcare. If you find my ‘potty mouth’ offensive, I suggest you grow up, grow a pair and go hang out somewhere else where your brand of bullshit isn’t so out of place and unwanted.

  3. Communism like they have in Cuba where they have the best healthcare in the world.

    • Cuban healthcare is a fascinating health topic. I’m not sure what metrics you use to say they have THE best healthcare but it’s certainly worth talking about. Imagine that a country cut off after the Soviet collapse from aid AND being embargoed from the USA could emerge so healthy! I’m no expert on Cuba but here’s what I think I understand… Healthcare without Pharma is much better. Period!
      Cuba after being cut off from imports took on a adopting Traditional Chinese medicine with it’s reliance on non patent formularies of medicinal herbs and methods of treatment. An interesting integrative masterpiece! While the USA suffers under the oppressive yoke of the Banking CABAL and it’s control over Pharma and Government agencies , the REAL free people in Cuba were able to get healthy. The USA has the worst first day infant mortality and overall longevity isn’t great either among industrialized countries. Definitely nothing to pound our chest about (hint- everybody representing crooked western medicine!) MOST fascinating about Cuban healthcare is that they have a similar vaccine schedule as the USA but suffer far less rates of Autism (1 in a thousand vs 1 in 50 roughly) and other vaccine injuries. While I’m not certain, I suspect far fewer vaccine adjuvant reactions and limited access to acetaminophen (Tylenol) are at the root. It appears that Cuba has its own vaccine manufacturing and a different approach to administering them. For instance, A new HEP-C vaccine developed by BIOCEN in Cuba relies on a nasal drops which is a safer route than injection. For an amazing explanation of the issues of vaccine administration delivery and it’s effects on cellular vs humoral immunity see the link below by Dr. Rebecca Carley M.D. ( a probable anti-vaxxer and conspiracy theorist :)) At least she’s not a Vaccine Science Denier!

    • “Healthcare without Pharma is much better.” Congratulations, you win dumbfuck of the month for that comment.

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