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Court upholds mental health benefits

By Taylor Sisk
Staff Writer

The Supreme Court’s decision to uphold most provisions of the Patient Protection and Affordable Care Act (PPACA) is good news for many previously uninsured North Carolinians with mental health and substance-use issues. The state legislature will now determine which provisions it may opt not to adopt.

Under the PPACA, beginning in 2014 no one can be denied insurance coverage due to a pre-existing condition. Insurers can no longer impose lifetime dollar limits on benefits, and annual limits will no longer be allowed after 2014.

The PPACA also provides subsidies to help people buy insurance. Health-insurance exchanges – online marketplaces in which individuals and small businesses can compare competing policies – will allow consumers to choose a private health-insurance plan tailored to their needs.

Julie Bailey, interim executive director of Mental Health America of the Triangle (MHAT), said that the upholding of the PPACA will have a positive effect on people living with mental illness or substance issues in several regards.

“One aspect I’m excited about is it opens options for treatment to many people who currently aren’t able to afford services,” Bailey said. “We know that mental illness is treatable and recovery is possible. We also know that about two-thirds of the people who currently live with a mental illness don’t seek treatment,” primarily due to affordability.

The PPACA requires that all plans sold in the exchanges include mental health and substance-abuse services coverage, and, Bailey said, this treatment will now be more affordable.

Doing away with exclusions for pre-existing conditions is another positive outcome, Bailey said.

“Here at MHAT we have seen clients move to a new job and been told by their new employer that they don’t qualify for a family health plan because their child has bipolar disorder,” Bailey said, “which has meant they can only have single coverage and have to find other ways to continue coverage to meet their child’s mental-health needs.

She also points to the elimination of lifetime caps on benefits as very important for those living with mental illness.

Bailey is particular pleased with the provision that allows young people to remain on their parents’ policies until they’re 26 years old.

“We’ve observed many young adults losing their health-care coverage between ages 18 and 23, and their treatment services stop almost instantly,” she said. “This is where they fall through the cracks in treatment and often where things fall apart for them with their illness and their ability to lead a successful, independent life.”

The road ahead

The campaign for more and better services now shifts to the states.

First is the question of whether the legislature will vote to create a health-insurance exchange in the state. Lawmakers closed their session last month without coming to a decision. If the state fails to establish an exchange by early next year, the federal government will run the state’s program. Thirty-three states and Washington, D.C., are now proceeding in creating exchanges.

Then there’s the question of whether the legislature will vote to expand Medicaid, a joint federal-state program for low-income Americans that often covers those with disabilities. The Supreme Court ruled that the PPACA provision to expand Medicaid eligibility to include anyone making less than 133 percent of the poverty line will be an optional one – each state has the discretion to expand its program.

The incentives are there, said state Rep. Verla Insko, pointing out that states will receive 100 percent federal funding for the first three years of services for those who were previously ineligible for Medicaid, tapering down to 90 percent thereafter.

“That first three years is the most expensive time when you bring a new population into Medicaid,” Insko said, and the federal government will be paying for it.

Insko also believes there will be pressure to opt into Medicaid expansion from hospitals, which now regularly provide unpaid emergency services to those with mental illness and substance-abuse issues.

“I think there will be pressure from the hospitals, from medical-care providers, from durable medical-equipment providers,” Insko said, “because they all stand to make more money.”

“I’m anxious to see how it all plays out in the end,” Bailey said, “and just hope that consumers don’t become greater victims while we all wait for the dust to settle.”

  1. Chris Weaver

    This is GOOD NEWS! the largest tax in US history in a plan to push Americans into an new entitlement system on the premise that congress can tax inactivity to protect a minority population while enslaving the rest under coerced benevolence is exactly NOT what this Nation was created to be. That would be Europe, where our founders fled from.
    Let us all ask our County commissioners( w/ their life time health benefits) to create a regulation that all Pr-existing auto collisions be covered by insurance!
    Woot! Would that not be GREAT?? heck…then…we would not need insurance…until AFTER a wreck! More top down solutions! More Central planning! More Bureaucrats to “help” streamline our lives for us! Oh this is GREAT! Health care SHOULD be like the DMV!
    There is nothing good in this. HC is in the mess it it in because of government…not due to the lack of it.
    Are we looking like 1930’s Italy yet?