SAMHSA’s Award-Winning Newsletter
September/October 2010, Volume 18, Number 5 

photo of an American flag with a stethoscope on it

Health Reform: What You Need To Know

What the Affordable Care Act Offers

Imagine a shift from “sick care” to true health care. That’s how U.S. Department of Health and Human Services Secretary Kathleen Sebelius, M.P.A., describes the transformation that health care reform is bringing to our health care system.

An emphasis on prevention pervades the Affordable Care Act (ACA). “Focusing on prevention rather than waiting until people get to the point where they have to be treated for some sort of acute illness just makes good sense,” said Secretary Sebelius. “We want to take down the barriers that are keeping folks from being as healthy as they can.”

Signed into law in March 2010, the Affordable Care Act will bring health insurance coverage to 32 million Americans who are currently uninsured. For those who already have insurance, the law offers new benefits, plus an end to practices that have kept people from being able to access health care just when they need it the most.

The law is especially good news for individuals with behavioral health disorders, said SAMHSA Administrator Pamela S. Hyde, J.D.

“Right now, estimates show that one-fifth to one-third of the uninsured are people with mental and substance use disorders,” said Administrator Hyde. “Of the estimated 32 million people we anticipate gaining coverage, about 6 to 10 million will have untreated mental illnesses or addictions we can actually help.”

New Benefits

Finding health insurance can be difficult for people with mental health and substance use disorders, explained Administrator Hyde. For one thing,insurers typically exclude individuals with pre-existing conditions. In addition, people with serious behavioral health problems may not be employed and thus lack the insurance coverage that often goes along with employment.

The result has been a widespread lack of health insurance among many of the people who need it the most, said John O’Brien, M.A., Senior Advisor for Health Financing at SAMHSA. “Thirty-nine percent of the individuals who are now served by state mental health authorities have no insurance now,” he pointed out. “And 61 percent of individuals served by state substance abuse authorities have no insurance.” ACA changes that.

In 2014

Beginning in 2014 (see timeline), insurers will no longer be allowed to deny consumers coverage because of pre-existing conditions or raise their premiums if they develop problems. Until then, consumers can turn to ACA’s new Pre-Existing Condition Insurance Plan for help.

In addition, coverage options will expand. An expansion of Medicaid will bring coverage to an estimated 16 million new enrollees, said Mr. O’Brien. “Forty percent of them will be under 30 years old,” he said. “That means we need to think about ways to engage that generation in treatment.”

Starting in 2014, individuals can also seek coverage from state-run exchanges—a new competitive marketplace for private health insurance that’s designed to give individuals and small businesses access to affordable coverage.

Essential mental health and substance use disorder services must be covered as part of the benefits package by all insurance policies offered through the exchanges and Medicaid.

Right Now

One group is already enjoying expanded coverage: adult children of the already-insured. Since September 2010, parents who purchase or renew insurance plans can obtain coverage for their children up to age 26.

It’s not just the uninsured who will benefit from Affordable Care Act, however.

The law’s emphasis on prevention, for example, means that consumers purchasing new plans will no longer have to face copayments or other forms of cost-sharing for preventive services, such as depression screening, drug and alcohol misuse screening, and smoking cessation efforts.

No Lifetime Caps

In addition, the law eliminates lifetime caps on benefits and restricts insurers’ use of annual caps for all new plans issued after December 2010. That’s huge, said Steven Randazzo, a special assistant in SAMHSA’s Office of the Administrator.

“Having a chronic condition or caring for someone with a chronic condition is expensive,” he explained. “This change means that you can keep going back to the doctor and keep your coverage.”

ACA also puts a stop to rescission—the practice of dropping patients from coverage, usually when their medical expenses are high—except in cases of misrepresentation or fraud.

Role of States & Providers

Reform means big changes to those providing services, too. “States are going to be involved more than ever,” said Mr. Randazzo. For one thing, states must establish their insurance exchanges and have them ready for operation in 2014. They must also prepare for the expansion of Medicaid.

That expansion will also trigger changes in SAMHSA’s Mental Health Services Block Grants and Substance Abuse Prevention and Treatment Block Grants. With more people receiving coverage for behavioral health services via Medicaid and the new exchanges, SAMHSA will redirect that funding to whatever gaps in service remain. “We have to figure out how to direct the dollars differently,” said Mr. O’Brien.


  Cover Story & Related Articles  
Health Reform: What You Need To Know

Health Reform: What You Need To Know

Health reform signals major changes for those with behavioral health needs.



  From the Administrator  
Leading Change

Leading Change

SAMHSA is taking a lead role in shaping health care reform policies. Read more.



  Suicide Prevention  
National Action Alliance Convenes

National Action Alliance Convenes

Launching a public-private collaboration to address the suicide crisis.

Breaking the Silence

Breaking the Silence

How many college students are lost to suicide each year?


  Military Families  
National Guard Trains Providers

National Guard Trains Providers

Behavioral health treatment providers experience boot camp.

November Is Military Family Month

November Is Military Family Month

A presidential proclamation and Veterans Day honor the Nation’s service members.

Real Warriors Get Help

Real Warriors Get Help

Behavioral health services are needed now more than ever.



  Oil Spill Update  
New Helpline for Gulf Coast Residents

New Helpline for Gulf Coast Residents

Toll-free helpline provides support. Call 1-800-985-5990.



  HIV/AIDS  
Hip-Hop Culture Builds Awareness

Hip-Hop Culture Builds Awareness

Hip-hop “Reaches youth where they are.”

Two Recent Conferences

Two Recent Conferences

SAMHSA’s Minority Education Institute, U.S. Conference on AIDS.



  Statistics & Data  
Drug Use Rises among All Ages

Drug Use Rises among All Ages

Drug use increased in 2009, especially marijuana use.



  Recovery Month 2010  
From

From “Active Addiction” to Recovery

At the Recovery Month launch, two people tell their stories. See event photos.



  Communications Update  
In Atlanta: Focus on Behavioral Health

In Atlanta: Focus on Behavioral Health

At the National Conference, SAMHSA officials focused on new technologies.

Scholarship Recipients Offer Feedback

What lessons learned came from attending the communications conference?

Special Session on Behavioral Health

Special Session on Behavioral Health

Why primary care physicians need to know “Behavioral Health is Essential to Health.”



  Older Adults  
In the ER: Older Adults & Illicit Drug Use

In the ER: Older Adults & Illicit Drug Use

How many emergency room visits involved illicit drug use by adults age 50 or older in 2008?



  Teens & Young Adults  
What a Difference a Friend Makes: Contest Winners

What a Difference a Friend Makes: Contest Winners

Entries show the importance of acceptance in recovery from mental health problems.

Violent Behaviors & Teens: Academics & Family Income Key Factors

Violent Behaviors & Teens: Academics & Family Income Key Factors

Nearly 7.8 million adolescents participated in violent behaviors in the past year.



  Also in this Issue  
Voice Awards Honor Former First Lady, Consumer Leaders

Voice Awards Honor Former First Lady, Consumer Leaders

Rosalynn Carter received the Lifetime Leadership in Behavioral Health Award.

New Quick Guide on TIP 42

New Quick Guide on TIP 42

Get at-a-glance information on substance abuse treatment for co-occurring disorders.



  Visit the SAMHSA Store  

Free Publications at Your Fingertips

The new SAMHSA Store offers publications and other Agency products. Visit store.samhsa.gov.

SAMHSA Store Video Tour

View the story of the SAMHSA Store.