The following points may be considered when making the case for the potential of the Affordable Care Act to make changes to the American health care system, and especially provide meaningful benefits and coverage for individuals with mental health and substance use conditions.
- Preexisting condition exclusions are prohibited in all plans starting in 2014 for adults and six months after enactment (September 23, 2010) for children. Insurers must accept every employer and individual that applies - guaranteed issue and renewability - beginning in 2014.
- Beginning in 2014, premiums may no longer be based on health status - instead only age, tobacco use, geographic area, and family size.
- Lifetime caps on the dollar value of benefits are prohibited in all plans starting six months after enactment and annual limits are restricted (as determined by the Secretary) until 2014 and prohibited after that.
- The law requires coverage of dependent children up to age 26 for all individual and group policies - effective six months after enactment (September 23, 2010).
- ACA requires the establishment of state-based health plan "Exchanges" by January 1, 2014 through which individuals and small businesses can purchase coverage with pooled risk and thus lower premiums.
- Premium and cost-sharing subsidies will be provided to reduce the cost of health insurance for those with incomes up to 400% of the federal poverty level ($43,000 for individuals and $88,000 for family of four).
- Small businesses with no more than 25 employees and average annual wages of less than $50,000 will receive tax credits for their insurance costs. Tax-exempt small businesses are also eligible for these credits.
- In 2014, Medicaid will expand to 133% of the federal poverty level (that is $14,404 for individuals; $29,327 for families of four) regardless of traditional eligibility categories (thus including childless adults). Connecticut and DC have opted to expand their Medicaid program early, and Minnesota is expected to follow suit in 2011.
- Enhanced federal funding for those newly eligible for Medicaid starts at 100 % federal and phases down to 90% federal by 2020. This will allow the states to have much less of the financial burden for the expanded population.
Mental Health and Substance Use Benefits
- Mental health care and addiction treatment are included on the list of essential benefits that must be covered in new plans offered to the uninsured through the exchanges. These benefits (and others on essential list including rehabilitative services, prescription drugs, preventive services, etc) will be further defined by the Secretary and include opportunities for public comment.
- The Mental Health Parity and Addiction Equity Act is expanded to apply to health insurance plans offered to small businesses and individuals in the Exchanges.
- Mental health and substance use benefits that are required of plans offered through the Exchanges will apply to those newly eligible for Medicaid through the expansion.
- The federal parity requirements will also apply to those newly eligible for Medicaid.