Last month marked the third anniversary of the Patient Protection and Affordable Care Act, a landmark effort to make health insurance coverage more affordable and accessible. Among the many provisions guiding health reform, the Affordable Care Act includes requirements to ensure the health care system provides adequate coverage for individuals in need of services for mental and substance use disorders. According to a report from the HHS Assistant Secretary for Planning and Evaluation (ASPE), the Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation.
Starting January 2014, an estimated 27 million uninsured individuals will have access to health insurance, and 25 percent of uninsured adults have a mental health condition or substance use disorder or both. The Affordable Care Act presents critical opportunities to improve access to care for these individuals. Building on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), the Affordable Care Act ensures that mental health and substance use services for newly covered individuals are provided at parity with medical and surgical benefits. The law also requires all new small group and individual market plans to cover 10 Essential Health Benefit categories, including mental health and substance use disorder services.
Improvements to the health care system will not only benefit individuals with behavioral health conditions, but also other groups who experience health disparities. Racial and ethnic minority populations are disproportionately uninsured, face systemic barriers to health care services, and often receive lower quality care and experience worse health outcomes. A concerted effort is needed to ensure that individuals from diverse racial and ethnic populations in need of mental health or substance use services are able to benefit from the expansion of coverage offered by the Affordable Care Act.
As the open enrollment period for the Health Insurance Marketplace approaches, targeted approaches for outreach and enrollment of diverse populations will be critical to reaching these vulnerable groups. The Office of Behavioral Health Equity at SAMHSA has partnered with four national associations (National Asian American Pacific Islander Mental Health Association, National Council on Urban Indian Health, National Latino Behavioral Health Association, and National Leadership Council on African American Behavioral Health) to identify and support the implementation of culturally appropriate outreach and enrollment practices, with the goal of increasing health insurance coverage among diverse populations.
Improved coordinated care and the integration of primary and behavioral health care, supported by Affordable Care Act provisions, will also benefit minority populations in need of mental health or substance use services. Individuals from racial and ethnic minority groups are more likely to seek services from primary care providers; therefore, integrated care models can increase access to behavioral health services. Coordinated care also offers the potential to provide improved services for prevention and early intervention. SAMHSA funds the Primary and Behavioral Health Care Integration program, to provide support to communities to coordinate and integrate primary care services into publicly funded, community-based behavioral health settings, resulting in improved access to primary care services; improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease; increased availability of integrated, holistic care for physical and behavioral disorders; and better overall health status of clients.
Through these provisions and an emphasis on reducing health disparities, the Affordable Care Act presents critical opportunities for making access to health care more affordable for diverse populations. Now as the federal government partners with communities, we can work together to ensure these opportunities become a reality.
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