Mental Health and the Affordable Care Act – Not So Fast !

Gentle Reader – Although this was posted in 2013, it remains true in January of 2020. This was an idiotic rule made for the implementation of the ACA. Yet another of the 320 million reasons that we really need Medicare for All. Mental health services must be properly funded and available.


There was some welcome news on the Affordable Care Act (ACA) front reported on Friday (November 8, 2013, New York Times).  On the front page of the Newspaper of Record, a bold headline stating: “Rules to Require Equal Coverage for Mental Ills ” trumpeted success ! Sort of.

What was little noted was something buried in paragraphs 12 and 13…..

“…The final parity rules do not apply to health plans that manage care for millions of low-income people on Medicaid. However, the administration has previously issued guidance to state health officials saying that such plans should meet the parity requirements of the 2008 law.

The parity law does not apply to Medicare, according to Irvin L. Muszynski, a lawyer at the American Psychiatric Association…”

So, let’s get this straight:

1. The new rules insist on parity in payment and access for mental and physical ailments;
2. The new rules apply to all of us who have insurance purchased through exchanges or privately and so forth;
3. The new rules DO NOT apply to the millions upon millions of us who are working poor and are obliged to use Medicaid Managed Care;
4. The new rules DO NOT apply to Medicare recipients.

So where is the parity ?

Medicaid, according to the latest MACPAC report, covers about 73 million of us AND CHIP (Children’s Health Insurance Plan) another 8 million…..81 million people is about 25% of our population. There are about 49 million of us on Medicare, according to The Henry J. Kaiser Family Foundation.  So this means that about 130 million Americans are receiving some form of State-supported insurance that may well NOT provide parity between physical and mental illnesses.

Mr. Obama, how is this right and fair ?  How will this limitation help prevent gun deaths by making available mental health services (Paragraphs 3 and 4 of the NYT article above) ? The mental health services may not be available !  The same MACPAC report I refer to above makes note of the number of physicians that simply will not enroll new Medicaid patients because of the poor payments related to that State – Federal program.

So, we have a problem.  Even if we put aside the fee schedule difficulties – Medicaid is a historically poor payor although this may be improved for Primary Care physicians soon – one of the very important issues that the ACA was to address – Parity in Mental Health Services – appears to be off the table for about one third of the American population.

Please explain to me, like I am a 6th grader, how this is right, fair, or good.

Gentle readers, I await your comments.

Is THIS quality health care ?

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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