In the months since the tragic shooting at Sandy Hook Elementary School in Connecticut, what used to be a relatively hush-hush topic in American health care policy has become an open secret: the U.S. mental health care system is littered with serious coverage gaps. The stigma associated with receiving such care, a lack of readily-available access, and high out-of-pocket costs all contribute to the fact that millions of Americans aren’t getting the mental health treatment they need.
Newtown forced mental health care into the national spotlight, and both states and the federal government have proposed reform proposals — some of which are worse than others — to increase funding for mental health programs and strengthen community resources for treating mental illnesses at an early stage. For instance, Obamacare requires private insurance plans on its statewide marketplaces to cover mental services as part of its “essential health benefits,” and early results indicate that a 2008 law mandating that large insurers treat mental health benefits in the same manner as more traditional care may be working.
But as Politico reports, the biggest challenge facing Americans seeking mental health care therapy is the exorbitant out-of-pocket costs associated with such care, since many psychiatric practices still refuse to accept private insurance coverage:
Andrew Sperling, a lobbyist for the National Alliance on Mental Illness, said, “There are a lot of private practice psychiatrists who refuse to accept the lower rates offered by a plan, particularly for outpatient services, so that can create an access problem.”
A 2008 survey by the American Psychological Association found that 85 percent of licensed psychologists reported receiving some third-party payments. But a majority of those claims were paid by federal, state and local government programs.
That means that many Americans struggling with mental illnesses must pay out of their own pocket for talk therapy — which can run a couple of hundred dollars for a session — and other treatments. […]
Those findings are even more worrisome considering the disproportionate effect that a lack of mental health care has on children enrolled in private health plans, where “there’s a tremendous dearth of practitioners… and of the few who are there, many, many of them don’t take insurance plans,” according to Debbie Plotnick, senior director of state policy for the advocacy group Mental Health America.
Surprisingly, government programs such as Medicaid offer fairly strong benefits for mental health patients, as Politico’s report shows. But the limited number of providers who accept private insurance for therapeutic care — and the high per-visit out-of-pocket costs such providers charge — lend some context to the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) finding that over half of Americans simply cannot afford the cost of mental health care. Unlike more traditional medical problems, mental health care treatment often requires ongoing therapy and outpatient treatments for which Americans are charged for every visit, making them less likely to purse essential care — and for children, the problem is even worse, seeing as 70 percent of children in need of mental care do not receive it.
Congress has recently introduced two separate bills to bring more integration between physical and mental care, as well as to provide schools and communities resources for early identification and treatment of mental health issues in America’s youth. But until steps are taken to encourage outpatient mental health providers to accept private insurance, Americans — and particularly American children — may still be unable to afford the coverage they need.