In media coverage about what a full Affordable Care Act (ACA) repeal would mean for Americans, the focus is usually on two main topics: insurance companies not being able to deny anyone with a pre-existing condition coverage, and young adults may stay covered on their parents’ insurance until they reach age 26. While those are important, there are still dozens of popular and critical benefits from the ACA that are at stake if Congress fully repeals the law. Loss of mental health parity protections, meaning equal treatment for mental health and substance use disorder conditions, is a key example.
The just-released Texas House Select Committee on Mental Health report recommends enhancing enforcement of mental health parity protections.
A full repeal of the ACA would move in the opposite direction. Full repeal would substantially reduce the reach of mental health parity protections, reducing access to mental health and substance use disorder (MH/SUD) care for 2.5 million Texans.[i] One of the less-publicized benefits of the ACA is that it extended the reach of mental health parity to types of insurance plans that had been previously excluded. An ACA repeal would mean millions of Texans would lose equal access to mental health benefits in insurance.
The Federal Parity Law
The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) aimed to fix the disparities in health insurance coverage of mental health and substance use disorder (MH/SUD) services. It was an important step forward in the fight to end discriminatory coverage of these services in health insurance policies; however, the MHPAEA as passed had a limited scope.
The 2008 law applied specifically to insurance offered by businesses with 51 or more workers. Importantly, the MHPAEA does not require health insurance plans to actually cover MH/SUD benefits. It only requires parity of benefits if MH/SUD benefits are already being offered.
The Affordable Care Act
The ACA expanded the reach of parity protections for consumers in two ways. First, it extended federal parity protections to previously exempt health insurance plans offered by both small employers and plans in the individual market (the individual market includes coverage bought directly from an insurance company, not offered through a job, both inside and outside of the Health Insurance Marketplace). Second, the ACA ensured that small employer and individual market plans would actually cover MH/SUD care by designating MH/SUD benefits as “Essential Health Benefits.” The ACA’s Essential Health Benefits create a floor for coverage, ensuring that plans cover basic and essential health care, including MH/SUD care and prescription drugs. Prior to the ACA, small employer and individual market plans often had skimpy, and sometimes non-existent, MH/SUD benefits.
Current Threat of ACA Repeal
The outcome of the presidential election has brought profound uncertainty to the future not just of the ACA, but of health coverage as a whole. If Congress fully repeals the ACA, the expansion of MH/SUD parity protections to the individual and small employer markets will be removed. Furthermore, the guarantee that individual market and small employer plans will actually cover MH/SUD services will cease to exist with a full ACA repeal.
Parity in Texas
Texas has its own parity standard, which is closely aligned with the federal MHPAEA that passed in 2008. Under this standard, in Texas, parity applies only to large employer health plans. State parity protections do not apply to individual and small employer plans. If Congress repeals the ACA, the existing state parity law would be insufficient to help the 2.5 million Texans with individual and small employer health plans.
What Is at Stake
Before the ACA, Texas had a patchwork of benefit standards that were full of loopholes with no blanket assurance of MH/SUD benefits or parity. The ACA successfully filled in major portions of the gaps. If Congress repeals the ACA, fewer people in need of MH/SUD services will be able to access care through their health insurance, making accessing needed health care unaffordable for many. Congress should not repeal the ACA until it has a clear plan of how any replacement will continue to ensure affordable access to MH/SUD care regardless of what type of health insurance coverage a person has.
Stay tuned to CPPP for more original reports that highlight often-overlooked key provisions of the ACA that will negatively affect Texans’ access to comprehensive, high-quality, affordable care.
[i] 2.5 million Texans had private health coverage insurance coverage in 2015 through individual market or small employer health plans, data from Texas Association of Health Plans, 2015 Enrollment Survey.