Affordable Care Act Coverage Expansions & Consumer Protections

Where We Stand

NAMI believes that all people with mental health conditions deserve accessible, affordable, and comprehensive health care. NAMI opposes public policies and laws that undermine or eliminate coverage expansions or consumer protections established by the Patient Protection and Affordable Care Act (ACA).

Why We Care

Before the ACA, comprehensive health insurance was inaccessible for millions of people in the U.S., including many people with mental illness. Health insurers could offer health plans that did not cover mental health services. Health insurers could deny, cancel, or charge more for coverage for people with conditions like mental illness. Medicaid, the public health insurance safety net, was limited to certain categories of low-income individuals and varied across the states. This meant that many people with mental illness were not eligible for public health insurance, could not afford private health insurance, could not find health insurance that included mental health coverage or were denied health insurance due to their mental illness.

In 2010, the ACA was passed into law and included a variety of coverage expansions and consumer protections to help improve the quality and affordability of health insurance and end many discriminatory practices. These include:

• Expanding Medicaid coverage for adults with incomes up to 133% of the federal poverty level
• Mandating coverage of mental health as one of ten essential health benefits in nearly all health plans
• Applying mental health parity protections to all new small group and individual market plans, so that coverage of mental health and substance use disorder services is on par with medical and surgical benefits
• Ending health insurers’ ability to cancel, limit, outright deny, or charge more for coverage of people with pre-existing health conditions (including mental illness)
• Prohibiting yearly and lifetime spending caps, so that people are not cut off from critical mental health services during periods of great need
• Extending family coverage up to age 26, giving young adults more coverage options at a time when many mental health conditions first appear
• Requiring coverage of a wide range of preventive services at no out-of-pocket cost
• Providing tax credits and cost sharing subsidies to make health insurance more affordable for individuals and families

As a result of the ACA, people with mental health conditions are more likely to have comprehensive health coverage and receive needed mental health services.

How We Talk About It

• Before the Affordable Care Act (ACA), people with mental health conditions struggled with finding and affording health insurance.
• Most states had no requirement that insurance plans cover mental health services, and health insurers could deny, cancel, or charge more for coverage for people with pre-existing conditions like mental illness.
• Before the ACA, finding comprehensive, affordable health coverage was a challenge for many individuals and families with low to moderate incomes. The ACA allowed millions of people to qualify for tax credits to help purchase coverage on the state and federal insurance marketplace, as well as offering cost-sharing assistance to help with health care expenses.
• The 2010 Affordable Care Act included many consumer protections, opening the door for many people with mental health conditions and substance use disorders to gain health coverage.
• Before the ACA, people with mental health conditions who did not earn enough to purchase insurance often did not qualify for Medicaid unless they were pregnant, elderly, or qualified for disability benefits.
• The ACA expanded Medicaid and allowed people to qualify for coverage based on income, rather than a disability determination, removing barriers to coverage for many people with mental illness.
• Before the ACA, young people were kicked off their parent’s insurance by early adulthood — a time when many symptoms of mental illness first start to appear. Thanks to the ACA, young adults with mental health conditions are now more likely to be insured and receive outpatient services.
• Health care coverage expansions and consumer protections mean that individuals and families are more likely to be able to get the mental health care they need and less likely to go into debt for getting that care.
• While the ACA remains the law, recent efforts have sought to weaken the law or repeal it entirely.
• NAMI continues to advocate for comprehensive mental health coverage and consumer protections at the federal level and supports efforts to strengthen state-level insurance requirements, oversight, and enforcement so that every person who needs mental health care has the coverage to get the help they need.

What We’ve Done

• NAMI report What the Affordable Care Act Has Meant for People with Mental Health Conditions — And What Could Be Lost
• NAMI report Mental Health Parity at Risk
• NAMI report Short-Term Plans Do Not Cover Life-Saving Mental Health and Substance Use Treatment
• NAMI press release “7 Health Organizations File Lawsuit Against the Short-Term, Limited-Duration Plan Final Rule”
• NAMI press release “NAMI Joins 16 Patient Groups to Protect Access To Health Care”
• NAMI press release “NAMI Calls Supreme Court Decision a Step Forward—and a Sigh of Relief—for People with Mental Illness”