ACA repeal leaves uncertain future for mental health patients

Over the course of his campaign, President Donald Trump repeatedly vowed to repeal and replace the Affordable Care Act without articulating the details of what a new plan would look like.

In particular, provisions of the law addressing mental health issues may be in danger of being scrapped without a replacement, according to mental health advocates.

Under the ACA, over 60 million mental illness and substance abuse patients received expanded protections in 2014, when health insurance providers were required to include equal treatment for mental and physical treatments.

Putting mental illness on par with physical conditions legally prevents insurance companies from discriminating against insuring people with preexisting and chronic mental disorders like schizophrenia, bipolar disorder and major depressive disorder, said Nicholle Karim, public policy director of North Carolina’s chapter of National Alliance on Mental Illness.

Karim said the ACA prohibits insurers from excluding coverage for preexisting conditions and dropping patients who reach their annual benefits limit.

“That’s huge because some mental health care can be really expensive and adds up quickly,” she said.

Jack Register, executive director of NAMI North Carolina, said even under the ACA, adequate access to medication and outpatient psychiatric care for many people can be time-consuming and cost-prohibitive.

It can take years to find the most effective medicines, Register said.

“So it requires a lot more trial and error on the part of the medical team, and because of the parity legislation and the non-exclusionary provision, it allows for us to make sure that folks have access to that,” he said.

Two UNC medical students, Camilla Powierza and Katie Weinel, helped establish Save Mental Health Reform, a nonpartisan organization advocating for the protection and expansion of the ACA’s mental health provisions.

Both Powierza and Weinel relayed stories of treating Chapel Hill and Charlotte mental illness patients who said their reliance on the ACA was a matter of life and death.

One of Weinel’s patients, a woman dealing with alcoholism and depression, was not able to afford rehab services nor a stay of more than a few days in the hospital because her condition was not covered by her insurance.

The most Weinel’s clinic could do was discharge the woman and refer her to an Alcoholics Anonymous group, something she had already tried without results.

“I have had quite a few patients in tears with fear of what will happen to ACA,” Powierza said.

Though he campaigned against the ACA, Trump acknowledged the need to reform mental health care nationally, particularly to address the growing opioid addiction in rural areas of the country.

The 21st Century Cures Act, passed with bipartisan support in November, ensures states enforce parity laws and provides federal funding and support for substance abuse research — which Karim and Register said may make it harder for the ACA provisions protecting mental health to be repealed.

“We’re hearing rumors of what’s happening in Washington, but no one has actually seen a plan,” Karim said. “So no one really knows what will happen.”

state@dailytarheel.com