Panacea Healthcare Services Blog

What Happens When Behavioral Health is Not an “Essential Benefit”

[fa icon="calendar"] Dec 20, 2017 10:00:00 AM / by Panacea Health Care Services

According to Partnership for a Drug Free America, one in ten Americans over the age of 12 was struggling with addiction in 2010. And, prior to the implementation of the Affordable Healthcare Act (ACA) only 11% of those affected received treatment.




The tides began to turn for behavioral health and addiction treatment when the ACA was signed into law in 2010. With the Medicaid expansion alone, more than 1.3 million Americans suffering from a mental health or substance abuse disorder were able to receive treatment, according to The Washington Post.


With the impending repeal of the ACA, which included a list of ten “essential benefits,” of which behavioral health care was one, we thought we would look at what it means when behavioral health is not covered by insurance.


A Return of Behavioral Health Disorders as “Pre-Existing Conditions”


There are several problems that arise when essential benefits are stripped from health plans. For one, individuals with pre-existing conditions can be charged more for coverage, or denied coverage all together. But the biggest issue is that an individual’s healthcare plan might not cover the services they need most. Where behavioral health is concerned, this means a reduction or complete loss of mental health care and addiction treatment.


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This means fewer people will be able to afford care. It could also mean that the care they do buy may not be as good.



According to Pacific Standard Magazine, prior to the enactment of the ACA, “18 percent of people who bought their own insurance didn’t have mental-health coverage. More than one-third didn’t have substance use disorders coverage.”


When Access Decreases, Overdoses Increase


As fewer people are able to afford care, those who are addicted will delay getting treatment, which could lead to diseases that are harder to treat, and an overall increase in overdoses, according to Stanford University professor of psychiatry Keith Humphreys.

This, of course, comes during the worst opioid crisis in American history.


According to the Department of Health and Human Services, more than 2 million Americans had an opioid addiction in 2015, 33,000 of which died of opioid overdoses that year.




A Potential Increase in the Cost of Care


One interesting side effect of the loss of essential benefits is that health plans won’t necessarily cover what people need most. This could mean that people who receive healthcare subsidies will use those subsidies to buy plans that don’t cover much. Thus spending taxpayer money without effective results.


But the cost of caring for the uninsured and indigent doesn’t go away when essential benefits are scrapped. If anything, the cost of their care rises the longer they wait to receive treatment, and according to the publication Hidden Cost, Values Lost: Insurance in America, those bills are pushed back onto everyone else in the system. 



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At this point, there is no telling what the new healthcare plans will look like once the ACA is repealed and the American Healthcare Act, or some permutation thereof, is enacted. But there is strong evidence to suggest that people struggling with mental health and substance abuse disorders will go longer without care, or fail to get the care they need in time.



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Topics: ACHA, ACA, Obamacare, Trumpcare, behavioral Health

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