By denying Medicaid expansion, Republican governors are sentencing the mentally ill to die
by David Atkins
Yesterday watched the extraordinary and powerful documentary The Bridge, about suicides on the Golden Gate Bridge. It led me to spend much of last night thinking about mental health in America.
In all the discussion of basic healthcare for the underserved, the young, the poor and those with pre-existing conditions, the impact of the Affordable Care Act on mental health may be among the most overlooked.
It’s important to remember that suicide rates in the United States have jumped sharply over the last couple of decades, including among those in middle age. The jump in suicides has spiked in particular after the recession. Also notable is that a common denominator in gun massacres does tend to be a history of mental health problems, such that in the absence of gun control increased focus on mental health services should in theory be something to draw support from both sides of the aisle.
One of the most common reasons for people not to seek mental health services is stigma. But cost and lack of insurance is another huge factor as well. The Affordable Care Act can help deal with that aspect:
Lack of insurance and the high cost of care are the biggest reasons mental-health patients don’t seek treatment, according to a study released in this month’s Health Affairs.
The Affordable Care Act supports increased access to mental-health services, with insurance coverage through the law’s exchanges set to begin Jan. 1 for those who sign up by Dec. 15. The full implementation of the ACA, according to a Health and Human Services report, will provide first-time access to mental-health services for roughly 32.1 million Americans.
The new health law requires all insurance plans in the exchanges and in the individual and small-group markets to treat mental-health services equal with other forms of care when it comes to co-pays and deductibles. In the past, insurance companies did not cover—or required higher out-of-pocket costs for—mental-health services. Stabenow proposed the parity amendment, which is now part of the ACA.
“People with mental illnesses are more likely to have lower incomes,” said Kathleen Rowan, a doctoral student at the University of Minnesota and the primary author of the study published in Health Affairs. “That’s because mental illness might be limiting in terms of the work they are able to do or the hours they are able to work. And so, many people face cost barriers in terms of access to care.”
The law will open the doors to affordable care for many of these individuals, Rowan said, through the subsidies on the exchanges and the expansion of Medicaid.
In 2010 there were 38,364 suicides in the United States–almost 5,000 more than were killed in car accidents. An untold number of others have died by the hands of those with mental health issues.
How many of those lives could have been saved with affordable access to mental health services? How many more lives will be lost in states that are denying affordable mental health care by preventing Medicaid expansion?
How many of these people, many of them poor, uninsured, taking unlicensed medications or self-medicating and at the end of their ropes, could have been stopped from making the fateful jump? How many Republican governors are sentencing people just like them to their deaths by denying them basic healthcare?