The Affordable Care Act (ACA), also known as Obamacare, was signed into law by President Barack Obama on March 23, 2010. The ACA represented the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. Among its many provisions, one of the most impactful aspects of the ACA in relation to mental health was its requirement that mental health services be covered by insurance.
The ACA expanded the reach of mental health coverage in several significant ways:
- Expansion of Medicaid: The ACA expanded Medicaid eligibility to include more low-income individuals, many of whom had previously been unable to afford any form of health insurance. This expansion included coverage for mental health services, which substantially increased the number of people who could receive these services.
- Essential Health Benefits: The ACA established a set of 10 “Essential Health Benefits” that all individual and small group health insurance plans are required to cover. Mental health and substance use disorder services, including behavioral health treatment, are included in these benefits. This marked a major change, as many insurance plans prior to the ACA did not cover or had very limited coverage for mental health services.
- Parity Requirements: The ACA also enforced and expanded parity regulations originally introduced in the Mental Health Parity and Addiction Equity Act of 2008. Parity laws require insurance companies to provide coverage for mental health and substance use disorders that is no more restrictive than coverage for physical health issues.
- Preventive Services: The ACA required coverage for certain preventive services without any cost sharing. This included screenings for depression in adults and adolescents, which can help in early detection and treatment of mental health issues.
As a result of these provisions, the ACA has had several effects on mental healthcare:
Increased Access: The ACA’s requirements for mental health coverage significantly increased access to mental health services. This is particularly true for low-income individuals who gained coverage through the expansion of Medicaid.
Reduction in Uninsured Rates: The ACA has also contributed to a decrease in the number of uninsured people. As mental health coverage is now required, this decrease in uninsured rates means that more people have access to mental health services.
Reduced Stigma: By including mental health services as a requirement and creating parity with physical health, the ACA has also helped to reduce the stigma associated with seeking help for mental health issues. Mental health issues are now more widely recognized as legitimate, treatable health conditions.
Improved Early Detection and Treatment: The requirement for preventive services, including screenings for depression, has also improved the early detection and treatment of mental health issues.