Why am I and why should you be concerned about the prospect of rolling back or eliminating healthcare reforms? If you or a family member has mental health needs, it’s important for you to understand how this could impact you and your loved ones. Let me tell you why, from my personal and professional viewpoint.
People who know me or have heard me speak publicly know my signature story: “Every gray hair says Ashley. And Ashley tells me that I should thank her for two things: my distinctive silver mane, and the direction of my policy and advocacy career. And I do.” Please allow me to tell you why.
My grown, beautiful daughter is a nurse, studying to be a nurse practitioner. She is married and about to make me a grandmother. But things weren’t always so rosy for Ashley. Between the ages of 14 and 18--a very common age-range when many mental health concerns arise--my daughter was deeply depressed, often suicidal, and was hospitalized several times. By age 16, she had reached our family’s employer-sponsored health insurance lifetime limit for mental health coverage. You may already know that there is a happy outcome, but it almost bankrupted my family to get there. And it really was the catalyst that propelled my professional career into mental health policy and advocacy.
During the years when I managed advocacy and direct service programs at one of MHA’s largest affiliates, Mental Health Association of Southeastern Pennsylvania -working to help people access a full array of community mental health programs -one of the most ardent wishes that my colleagues and I shared was the dream that the people we served could also have access to healthcare treatment for the other multiple, chronic, cooccurring conditions they almost always had.
With passage of the 2008 Mental Health and Addiction Equity Act (MHAEA), some families dealing with mental health needs did see some relief from unequal mental health coverage and exclusions. But the provisions of this law only applied to employer-sponsored insurance plans provided by companies that employed more than fifty people, and which were not self-insured plans. Even for the limited number of plans where parity was required under this law, the employer could still elect to not cover mental health at all. Most employer-sponsored plans were still not covering mental health on par with other health needs. And Medicaid, which is the largest payer for mental health services and community supports, in almost all circumstances, required people to be declared disabled before they were eligible for coverage. So, most people could not access mental health services. More - much more - needed to be done.
In 2010 with the passage of the ACA, we saw progress. While it wasn’t perfect, and the Supreme Court made its state Medicaid expansion provisions optional - for people with mental health conditions, their families, and for me and my fellow advocates - the ACA went a long way in making our healthcare advocacy dream come true.
Health care reform made mental health and substance use treatment an “Essential Health Benefit.” This means that all insurance plans must provide coverage, without lifetime limits. And they do so at parity—meaning they couldn’t have higher copays or more limitations for mental health and substance use services than they did for other health conditions. It meant that people who’d been treated for mental health or other health conditions were no longer unable to buy insurance because they had “pre-existing conditions.” It meant, in all but a handful of states, people with low-incomes could access Medicaid who were not disabled, or not parents of young children. And it meant that young people at the vulnerable time when major mental health conditions often hit, they could stay on their parents’ insurance until they were 26.
This is why we should ALL care about threats to the ACA. We need to protect health care reform, and the strides our community has made to address mental health parity.
If someone in your family, or the people you work with or for, have benefited from these ACA reforms, please join me in telling your members of Congress. Call, write, email. Use social media platforms like Facebook or Twitter to tell them your story. Tell them how these provisions have helped you and your family, and tell them why rescinding these provisions would hurt people in their district, in their state. Do it today.