Health Care Reform and Mental Illness

Eileen Bailey Health Guide
  • Mental illness is one of the most costly medical conditions in the United States. According to the National Institute of Mental Health, 36.2 million Americans spent 57.5 billion dollars in 2006 (the most recent year this data is available for.) The National Alliance for Mental Illness (NAMI) completed a survey in 2003 to measure how effectively health insurance covers the needs of patients with mental illness. Both patients and family members completed the survey. Of those using private health insurance (individual and group coverage), only 17 percent indicated their insurance adequately covered treatment. In addition to inadequate coverage, many individuals were denied coverage based on their mental illness.

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    Last year the Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act of 2010 were signed into law. These laws afford some protections for patients with mental illnesses, including anxiety disorders and we'll look at the benefits to mental illness treatment later in the post.


    The Health Parity and Addiction Equity Act of 2008


    There have been health care reforms specifically geared toward mental illness prior to the 2010 laws. The Health Parity and Addiction Equity Act of 2008 mandated that for groups of more than 50 people, Medicaid managed care plans and some of the State Children's Health Insurance Programs; psychiatric disorders must be paid in the same way other medical illnesses are paid under the plan. Prior to this act, many health insurance plans contained separate deductibles, co-payments, and annual and lifetime limits for psychiatric conditions and substance abuse. For example, therapy visits were frequently paid at 50% instead of 80% for doctor's visits for other medical conditions. There may also have been a limit, such as only 20 visits per year.  Although this law was a positive step, it didn't address all of the problems associated with those with mental illness having access to the care they need. For example, the law does not require employers to provide coverage for mental illness; it states that if mental health coverage is offered, it must be offered at the same payment rates as any other medical condition.


    The Affordable Care Act of 2010


    This act works to make health insurance more accessible to all Americans. The legislation requires individuals and families to have health insurance, much like many states require individuals to carry automobile insurance. Because not everyone can afford private health insurance, the law includes:

    • Subsidies for low income individuals and families to help cover the cost of insurance
    • Increased eligibility for Medicaid
    • Incentives for employers to offer health insurance

    In addition, the law requires that health plans include mental illness and substance abuse treatment and services.


    Those with mental illness also have a hard time finding health insurance. Many of those with serious mental illness are unemployed and don't have access to employer funded health insurance. Private health insurance often denies coverage based on pre-existing conditions or the premiums are so high they are unaffordable. The health insurance reform provides protections to people with mental illness, such as:

    • Insurance companies cannot deny coverage or refuse to renew a policy based on pre-existing conditions. A policy must be offered to everyone who applies.
    • There can be no annual or lifetime limits in the policy meaning that claims must be paid as long as the policy is in force.
    • Premiums cannot be increased because of mental illness.
    • Young adults, up to age 26, can remain on their parent's policy.

    These reforms should help those with mental illness have access to health insurance.

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    Health Insurance Exchanges


    The health insurance reform law requires insurance exchanges to be created by January 1, 2014. These exchanges will act as brokers and sell insurance plans to individuals and small businesses (large companies will be able to purchase insurance through the exchanges after 2017.)


    Policies sold through the exchanges should cost less but provide good health coverage. There may be differences in the plans offered through the exchange. These differences can include different co-pay amounts, different benefit packages and different premiums. Using an exchange will help you compare different plans to make the best decision for your situation.

    All policies offered through the exchanges must include at least a minimum range of services:

    • Mental health and substance abuse services
    • Have coverage for hospitalization, emergency room services, outpatient, prescription drugs and preventive services.

    Individuals with mental illness, if purchasing a health plan through an exchange, will be sure that their medications, therapy and inpatient hospitalization is covered.




    "Are People with Mental Illness Getting the Help They Need?" 2000, Author Unknown,


    "How Will Health Reform Help People with Mental Illness", 2010, Chris Koyanagi, Bazelon Law Center


    "What you said about health insurance coverage for people with mental illness," 2004, National Alliance for Mental Illness



Published On: February 21, 2011