Health Care Reform Contains Major Expansion Of Access To Mental Health Services

By Amanda Terkel

WASHINGTON -- The health care law that Republicans are targeting for repeal provides significant assistance and options for people with mental illness, an issue that has received increased attention as details emerge about the alleged shooter in Arizona on Saturday.

"The shooter was a very disturbed individual and it appears there were so many warning signs that he was going to do something horrible," Rep. Allen West (R-Fla.) wrote on his Facebook page. "We should be focusing on the mental health crisis in our country, not politics."

As Igor Volsky of ThinkProgress points out, Rep. Mike Rogers (R-Mich.) similarly told MSNBC Tuesday, "A bad guy is going to get a gun. What we have to do is "intervene earlier in that cycle of violence when they have this kind of mental disability."

Lawmakers looking for a way to boost mental health services might want to start by checking out last year's Patient Protection and Affordable Care Act, which both West and Rogers support repealing. Mental health advocates have hailed the law for its expansion of access.

In 2008, President George W. Bush signed landmark "parity" legislation requiring employers to provide mental health insurance benefits comparable to traditional medical coverage. It also barred insurance companies from setting higher co-pays or deductibles for mental health services.

That law, however, applied only to people who already have insurance. Chris Koyanagi, policy director at the Judge David L. Bazelon Center for Mental Health Law, told The Huffington Post that the Obama administration's signature health care law is at least as key.

"While the 2008 law was very important in terms of people who have insurance through their employer, the great thing about the Affordable Care is that it's everybody," said Koyanagi, whose organization has produced a report on the 2010 law's impact. "If you have a serious mental illness, you have trouble staying employed. There's a whole group of people for whom parity would never have applied without this statute. We've had a lot of people just falling right through the cracks because they don't come with any way to pay, and they're the folks with the most serious problems."
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Koyanagi highlighted two major elements of reform: More Americans are projected to be enrolled in private insurance under the 2010 law, which is required to provide coverage for mental health and substance abuse services, and it is also expected to significantly increase Medicaid availability.

"The expansion of Medicaid to people with incomes under 133 percent of poverty who would not otherwise have been able to get on the Medicaid program is going to include a lot of people with mental health needs," she said.

Before the Affordable Care Act, low-income childless adults with severe mental illnesses were not able to get Medicaid assistance, and therefore had no way to pay for mental health services. "Certainly the repeal of ACA would drastically hurt a lot of childless adults with serious mental illness who need treatment," Koyanagi said.

Acquaintances of Jared Lee Loughner, the man charged in Saturday's Arizona shootings, have described him as a troubled individual with worrisome behavior. One of his community college classmates wrote in an email about Loughner, "We have a mentally unstable person in the class that scares the living crap out of me. He is one of those whose picture you see on the news after he has come in to class with an automatic weapon."

Dr. Anthony Lehman, a professor at the University of Maryland School of Medicine, said that early reports on Loughner seem to follow a familiar pattern (with an atypical outcome) of the "failures of mental health systems to respond to young people with serious mental illness."

"As I understand, he began having problems as early as high school, dropped out of high school and was identified as someone who was having problems, and then proceeded in some of the history that we just heard about with involvement with the police and problems in college, but never received, I guess as best we know, any mental health treatment," Lehman said on PBS's "Newshour."

Despite the recent attempts to expand access and services, mental health is still woefully undertreated. In the past year, Arizona's Pima County, where Rep. Gabrielle Giffords (R-Ariz.) and 19 others were shot Saturday, has seen more than 45 percent of its mental health services recipients forced off the public rolls.

In response to the shooting, House Republican leadership postponed its vote on the Repealing the Job-Killing Health Care Law Act, which was supposed to take place Wednesday. The House is expected to pick it back up next week.

Neither West nor Rogers returned calls seeking comment.