Mental Health Coverage Requirements If States Get A Waiver

As the Senate prepares for a vote on its Repeal and Replace healthcare bill, those interested in mental health coverage have several concerns.  The cuts to Medicaid will significantly reduce the number of lower income people who can pay for mental health services.  When you take $800 billion out of Medicaid and then lower the inflation rate ten years from now, fewer people will have access to fewer healthcare services. 

Another big issue is the loss of mental health coverage as an essential health benefit required in individual plans.  Under the current Affordable Care Act (Obamacare), insurers providing insurance to individuals through the subsidized insurance exchanges must provide coverage for ten essential areas including hospitalization, maternity, prescription drugs, and mental health.  The Senate bill (and the House bill) would allow states to obtain waivers so that some of these coverages such as mental health would no longer be required in individual plans.  People may find they can get coverage, even cheaper coverage, but it doesn’t cover what they need if they need mental health services.

Before the Affordable Care Act became law, mental health coverage varied widely, depending on state requirements or lack of them.  Some plans didn’t include mental health because it lowered the cost.  Others included it knowing they could deny coverage to someone based on their medical history.  That is no longer officially an option, but with a state waiver, insurers could again offer plans with no mental health coverage.  How likely is that to happen?  We can get an idea if we look at what coverages were offered before the Affordable Care Act.  Which is what the Kaiser Family Foundation has done.  Their study shows that in 2013 mental health services were not covered in 38 percent of individual plans.  Kaiser also found that outpatient substance abuse services were not covered in 45 percent of individual plans.  You can read the Kaiser article here. 

You can find Kaiser's comparison of the Senate and House healthcare bills with current law here.

You can contact your Senators through the Capitol switchboard at 202-224-3121.