Health Care Reform
Commonly referred to as the Affordable Care Act (ACA), the federal health care reform bills signed into law in 2010 present numerous opportunities to improve patients’ access to high quality health care, including access to adolescent mental health screening and mental health services. For an overview of the most significant new consumer protections and benefit standards, see our fact sheet on health care reform and mental health parity.
By 2014, the ACA is expected to expand access to care to an additional 30 million Americans by requiring individuals to purchase coverage; extending subsidies to low and moderate income families to enable them to purchase coverage; and expanding eligibility for Medicaid coverage starting in 2014.
Increases Access to Preventive Services
In addition to expanding health insurance coverage, the ACA places a strong emphasis on improving access to preventive health services. Describing this emphasis, Secretary of Health and Human Services Kathleen Sebelius has stated: “The biggest change we can make isn’t how we provide health care, it’s when. Right now we have a sick care system, and we need to invest in a health care system.”
Under health care reform, many preventive services are now required to be covered by health plans without cost-sharing, i.e., a copayment, coinsurance or deductible. For children and youth, preventive services that are subject to this protection include:
- All services recommended by the United States Preventive Services Task Force (USPSTF)
- Preventive services recommended in Bright Futures guidelines as endorsed by the Health Resources and Services Administration
- Immunizations recommended by the Centers for Disease Control and Prevention
These recommended preventive services include:
- routine behavioral health assessments
- adolescent depression screening for youth ages 12 to 18
For details, see our fact sheet on health care reform and mental health screening. For a full list of covered preventive services, visit http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html.
Establishes Essential Benefits
The ACA also requires coverage of essential benefits for health plans that will be sold through the new health insurance Exchange, which is scheduled to begin operating in 2014. The law requires that these essential benefits include a number of broad categories of benefits, including mental health and substance abuse services.
More detailed guidance about what benefits will be covered will be addressed in forthcoming regulations. See the Coalition for Whole Health recommendations on mental health and substance abuse services that should be covered as essential benefits.
Strengthens Mental Health Parity Protections
Prior to the passage of health care reform in 2010, certain types of health insurance plans were not subject to mental health parity protections. The ACA extended mental health parity protections to adult Medicaid coverage (youth up to age 21 already had coverage for mental illness and substance use disorders under the EPSDT benefit). It also strengthened mental health parity protections by eliminating all lifetime and annual benefit limits on health insurance coverage, including for coverage of mental health and substance abuse disorders.
Promotes Health Care Quality Improvement
Despite spending a higher proportion of our gross domestic product on health care than any other nation, the United States’ health system was ranked just 37th out of 191 countries by the World Health Organization in 2000. The health care reform law includes numerous health care quality improvement provisions, which have the potential to improve health care delivery and associated patient outcomes.