Introduction
Mental illness is a common condition in the U.S, which triggers disproportionate impacts on the populace. According to Seo et al. (2019), around one in five adults in the U.S live with a psychological condition. In 2018, approximately 51.5 million people aged 18 and above had a mental disorder in the U.S (Seo et al., 2019).
Its incidence was significantly high among females (24.5%) compared to males (16.3%) (Seo et al., 2019). Various health-related policies have been developed in the U.S to address this issue. These procedures aim to minimize the incidence rates of psychological conditions within the population, improve access to appropriate interventions, and enhance positive health outcomes. This paper seeks to evaluate the efficacy of one of these policies, particularly the Affordable Care Act (ACA), in promoting mental health practice.
A Description of the Policy
The Patient Protection and Affordable Care Act (PPACA) is distinguished as a detailed reform within the U.S healthcare sector, signed or passed as legislation in March 2010 by the former U.S President, Barrack Obama. The ACA is a U.S public health policy watershed, which was revised by the Health and Education Reconciliation Act (Creedon & Cook, 2016). Through a sequence of amendments and extensions, the ACA represents the healthcare system’s legal model in the U.S. It establishes the fundamental licit protections, which, until its inception, were absent.
Provisions of the ACA
Provisions under the ACA are aimed to curb the increasing healthcare expenses, expand the health workforce, enhance better systems and quality performance, emphasize wellness and disease prevention, expand insurance access, and promote consumer protections. These stipulations may be organized within three fundamental objectives:
- Continuous and universal healthcare insurance access: The two major procedures for enhancing better insurance coverage include 1. Medicaid coverage expansion. 2. The establishment of online marketplaces or health insurance exchanges for certified and government-regulated insurance plans.
- Health insurance affordability: The legislation underscores the provision of subsidies for health insurance purchases through tax credits for U.S citizens with modest incomes. A wide range of grants is available for specific groupings.
- Care and coverage adequacy: The legislation delineates fundamental benefits in ten primary categories that should be integrated into all insurance plans.
The CMS (Centers for Medicare and Medicaid Services) was tasked with developing contemporary healthcare provision frameworks. This was due to likelihood of the increasing influx of patients into the healthcare system, which could trigger significant surges in aggregate healthcare expenditures. These models could enhance better healthcare quality while minimizing or stabilizing costs. The ACOs (Accountable Care Organizations) is an example of the model.
According to Huguet et al. (2018), it refers to a network of healthcare providers who share care costs and medical responsibility for a specific patient group. The above-mentioned model preceded the ACA as an option to the conventional payment system – fee-for-service. Another healthcare delivery framework devised by the CMS is health homes. This model operates at practitioner teams’ level instead of networks.
According to Thomas et al. (2019), health homes encourage the delivery of team-based and patient-centered care coordination for people with various chronic illnesses, including substance abuse and mental health disorders. This model was intended to improve care quality and enhance significant cost reductions by minimizing emergency department (ED) and hospital use.
Social Issues that Led to the Development of the ACA
Many forces intersected to demand healthcare reform within the U.S due to various issues. Over the previous several decades, there was a significant surge in care costs. This phenomenon was ascribed to the rapid advancements in treatment and diagnostic processes. Substantial healthcare costs were also attributed to the effects triggered by non-competitive payment models.
The healthcare setting’s revenue and physicians’ income relied on the number of patients seeking primary care and implemented medical procedures. During this era, many Americans acquired health indemnity through employer-sponsored insurance plans. To control the increasing healthcare costs, insurance organizations denied coverage to people with pre-existing illnesses and revoked coverage whenever they became ill, and decreased the benefits guaranteed under insurance plans.
Enterprises also initiated approaches that triggered the eradication of family plans and limited workers’ options regarding coverage plans. This consequently led to significant increases in the rate of individuals without health insurance. According to Thomas et al. (2019), approximately 48 million people in 2010 were uninsured due to the conventional practices within the healthcare sector. These individuals often lacked preventive services, and, according to Huguet et al. (2018), they only sought medical interventions in instances where their underlying health conditions were unbearable or critical.
Furthermore, Kminski et al. (2017) indicate that emergency medical interventions were typically costly than routine care. As a result, medical-related expenses become the primary cause of individual bankruptcy in the U.S. However, following the ACA’s implementation, healthcare access for all individuals, including those with chronic illnesses and mental health conditions, increased significantly. The Act also initiated significant modifications in the coverage benefits provided by insurance plans, and the U.S experienced a surge in the rate of insured people. Employers were also mandated to provide insurance to all their workers.
The Population Targeted by the ACA
Traditional Medicaid Beneficiaries
Under the preventive benefits section, the above-mentioned policy (ACA) classifies adult beneficiaries into two primary groups. The first category includes newly qualified recipients whose insurance coverage encompasses “vital or crucial health benefits” consisting of preventive services stipulated by the Public Health Service Act. The other grouping consists of conventional Medicaid beneficiaries who are still entitled to the long-established benefits package under Medicaid. According to Seo et al. (2019), preventive services have been distinguished as a federal requirement for this populace segment, particularly those aged 21 and below. For adults aged 21 and above, this service is optional.
Pregnant Women
The statute renders services that promote tobacco cessation an essential benefit for the above-mentioned populace segment. According to Seo et al. (2019), care delivery services included under tobacco cessation include pharmacotherapeutic approaches, including non-prescription and prescription medications sanctioned by the FDA (Food and Drug Administration), counseling, therapy, and diagnosis. This is in accordance with the guidelines by the Public Health Service (Thomas et al., 2019). These services may be provided by physicians or under their supervision, or by other licensed and authorized healthcare practitioners.
Individuals with Pre-existing Conditions
The ACA mandates the HHS secretary to provide grants to U.S-based states to establish chronic disorder programs for Medicaid recipients. According to Mechanic and Olfson (2016), the above-mentioned stipulation is contained under section 4108 of the ACA. Initiatives established under this program are usually easily accessible, widely available, evidence-based, comprehensive, and are designed and specifically suited to this populace segment’s needs. Grants awarded to states should be used to perform education and outreach campaigns to increase the community’s awareness.
Individuals Eligible for Family Planning Approaches
The ACA developed a new state qualification option regarding coverage for supplies and services for family planning. Under this provision, states may opt to extend insurance coverage to specific people who may be considered ineligible for Medicaid for financial or categorical reasons. Benefits under this provision include supplies and services that promote family planning as well as the therapeutic and diagnostic approaches related to family planning.
Evidence-Based Practices That may be Implemented as a Result of the Policy (ACA)
Strategies to Manage Smoking and Dependency/Addiction
Nicotine Replacement Therapy (NRT)
The most widely researched and utilized the pharmacotherapeutic approach for managing nicotine withdrawal and dependence is the therapeutic utilization of medications containing nicotine. NRT products assume several forms, including tablets, oral inhalers, nasal sprays, transdermal patches, and gum. Kruger et al. (2016) identify transdermal patches as a gradually sustained release approach for nicotine delivery, while tablets, oral inhalers, nasal sprays, and gum as acute dosing nicotine forms.
NRTs act by providing breakthrough and general craving nicotine relief with the instant elimination of nicotine. Several evidence-based pieces of research endorse NRTs’ use in smoking cessation. For instance, a survey by Hartmann-Boyce et al. (2018) revealed that all approved NRT forms increase an individual’s chance of terminating tobacco smoking successfully. According to Hartmann-Boyce et al. (2018), this approach increases one’s likelihood of ending this behavior by fifty-to-sixty percent.
NRT’s intervention’s efficacy does not depend on the potency of additional support given to the patient. Another study by Krishnan et al. (2017) identified NRT as the most effective approach for facilitating smoking cessation. These researchers further recommended increasing the duration and supply of NRT to enhance its efficiency in eradicating this deportment.
Furthermore, a qualitative study by Silla et al. (2014) revealed that people who use NRT are usually highly inclined to terminate tobacco smoking compared to non-users. According to Silla et al. (2014), these individuals are also likely to implement techniques or approaches which reinforce their cessation attempts. To achieve better outcomes, this evidence-based methodology may be combined with behavioral therapy.
The “5A’s”
Successful interventions typically commence with distinguishing users and effective interventions based on an individual’s willingness or commitment to quit. The five primary therapy phases incorporate the “5A’s”: arrange, assist, assess, advise, and ask (Chai et al., 2018). Below is a description of each phase:
- Ask: It involves distinguishing and documenting the status of tobacco use for each patient during every visit.
- Advise: This should be conducted in a clear, personalized, and strong manner. Practitioners should encourage every tobacco using patient to quit.
- Assess: This involves evaluating the willingness of the patient to initiate an attempt to quit smoking.
- Assist: Pharmacotherapy and counseling should be initiated when the patient is committed to terminating the behavior.
- Arrange: This phase underscores the need to schedule follow-ups ideally within the initial week following the quit date.
Studies highlight this intervention’s efficacy in enhancing smoking cessation and improving patients’ knowledge of the behavior’s impacts. For instance, a survey by Chai et al. (2018) revealed the efficacy of the 5A comprehensive approach in enhancing an improved cognizance of anti-smoking attitudes and smoking among migrant workers.
The research outcomes of a study by Kruger et al. (2016) indicated that the “5A’s” intervention was linked to substantial improvements in the use of medication and counseling aimed to promote smoking cessation among patients. From the results of the above reviews, it is evident that the “5A’s” approach is crucial in enhancing smoking cessation approaches and improving patients’ insights into the impacts of this behavior.
Evaluation of the Policy
Affordability
The ACA has been associated with positive and negative views with regard to affordability. The coverage expansion under this policy has triggered significant improvements in insurance coverage, with the rate of uninsured individuals decreasing from 16% to 9.1% from 2010 to 2015; this is a 43% decline (Manchikanti et al., 2017). Between 2010 and 2016, the U.S recorded a substantial reduction in the uninsured people’s number from 49-to-27 million (Manchikanti et al., 2017).
Dependents’ coverage (up to 27 y/o) to over 2 million in early 2015. Non-elderly’s access to a private physician registered a 3.5% increase, while medication access increased by 2.5% (Manchikanti et al., 2017). A 5.5% decrease was recorded among individuals unable to afford care, whilst records for poor health outcomes reduced by 3.4% (Manchikanti et al., 2017). Contrarily, Enrolment to healthcare exchanges recorded significant failures typified by fewer registrations than anticipated; this may be ascribed to out-of-pocket expenses and high premiums.
Cost/Expense Containment
The U.S healthcare sector has recorded significant reductions in the growth rate of pertinent expenses. There have been substantial improvements in workers’ financial risks with regard to healthcare costs with a decline in the prevalence of employees without a yearly out-of-pocket expense limit.
Following the ACA’s implementation, the healthcare sector’s payment systems have undergone considerable changes, including modifications in Medicare Advantage programs’ compensation rates and adjustments in the reimbursement of the private sector. Contrarily, the ACA decreased medical care affordability due to the surge in out-of-pocket and health insurance costs; this includes increased premiums, co-insurance, and deductibles.
Quality Improvement
This policy has also been linked with considerable improvements in healthcare quality. For instance, According to Manchikanti et al. (2017), there has been a 17% significant reduction in the incidence of hospital-acquired diseases (HAI), including pressure ulcers, infections, and adverse drug cases between 2010 and 2014. Furthermore, the AHRQ (Agency for Healthcare Research and Quality) outcomes linked HAI declines with 87.000 prevented demises over four years (Manchikanti et al., 2017).
Contrarily, this policy has been correlated with significant increases in patient waiting times and the decreased contributions to preventive disease services. The adoption of electronic health systems (EHR systems) has also been correlated with a high skepticism concerning its efficacy in quality improvement, with multiple physicians expressing their frustrations with the technology.
The Impact of the Policy (ACA) on Access to Mental Health Services
As indicated earlier, there were over 48 million uninsured individuals in the U.S before the passage of the ACA; this statistic consisted mainly of the low-income populace. This population segment has been correlated with the increased incidence of psychiatric disorders. Before the ACA’s enactment, the Mental Health Parity and Addiction Equity Act and Mental Health Parity Act demanded that all large-grouping employer insurance coverage offering psychological health services guarantee their coverage (Thomas et al., 2019).
This was to be done at a level similar to surgical and medical services. However, these legislations were not applicable to small- and individual-group programs. Depending on a person’s coverage type, insurers typically screened clients for any previous history of mental health and utilize this knowledge to cap and exclude services linked to mental health, deny coverage, limit drug access, and increase cost-sharing and premiums.
However, the ACA’s passage helped address these issues by joining mental healthcare access with coverage expansions. Strategies to increase insurance coverage caused a substantial decrease in the uninsured populace’s rate to around 30.4 million in 2018 (Mechanic & Olfson, 2016). These approaches include allowing the young populace segment to maintain their eligibility for receiving healthcare using their parents’ plans until they attain 26 years and expand the Medicaid program (Mechanic & Olfson, 2016). The policy also warranted mental health service access within Medicaid expansion programs and the small-group and individual plans (fully insured).
The ACA mandated the integration of ten vital health benefits (this includes prescription drugs and mental health) into these insurance programs. The statute also endorsed the incorporation of the MHPAEA parity stipulations to the above-mentioned plans and demanded all programs cover preventive approaches such as the screening for conditions related to psychiatric health at zero costs (Mechanic & Olfson, 2016).
The policy also emphasizes that small-group and individual plans meet the adequacy standards established by provider networks. The statute also terminated the lifetime and annual benefit caps, and it also eradicated medical underwriting which is prevalent in small-grouping and individual marketplaces. Currently, insurance programs cannot impose cost impediment and deny coverage due to patients’ underlying mental health disorders.
The Policy’s Impact on Social Workers
ACA’s enactment facilitated the integration of social work practice in the healthcare sector by expanding its scope. A study by Bachman et al. (2017) supports this viewpoint by arguing that these professionals under the above-mentioned specialty play an instrumental role in facilitating the attainment of the ACA’s primary objectives. These goals include improving healthcare quality, minimizing healthcare costs, and increasing insurance coverage.
According to Bachman et al. (2017), social workers currently assume various health-related duties in the healthcare setting, including behavioral health counselors, care coordinators, and patient navigators. Regarding mental health, social workers can integrate clinical interventions, including short-term psychotherapy, disease management groupings, and cognitive-behavioral therapies during patients’ hospitalization to trigger significant improvements in health outcomes while minimizing utilization and costs.
Following the ACA’s sanctioning social workers’ demand and roles in primary care settings and health, homes increased significantly. Social workers typically play critical roles in public health and prevention interventions by encouraging patients’ adherence to medications, offering home visitation services, and addressing mental health, childhood obesity, and other chronic conditions. These settings allow these experts to integrate their behavioral health skills, as well as disease prevention and health promotion adroitness during care delivery to ensure the achievement of positive patient outcomes.
Furthermore, case management adroitness possessed by social workers has also been identified as crucial proficiencies required to attain the ACA goals. According to Bachman et al. (2017), these professionals are usually trained to evaluate clients’ environments and strengths; this role is congruent with the ACA’s new functions, including patient navigating. Social workers could also be instrumental in advocating for the needs of hard-to-reach populaces. Contrarily, the ACA has triggered an increased demand for social workers to engage in professional research, enroll for specialized training, and enhance this specialty’s professional distinction.
Entitlement Programs Impacted by the ACA
Social security benefits
Non -taxable benefits linked to social security, including SSDI (social security disability income), are typically regarded as income under the ACA, which impacts tax credits. Therefore, this means that when computing one’s subsidy eligibility, their social security income (SSI) is utilized to ascertain their qualifications and may impact the amount they are entitled to (Seo et al., 2019).
This viewpoint is supported by Kominski et al. (2017), who argue that a person’s eligibility for subsidized health coverage plans and income-based Medicaid is usually calculated utilizing a household’s MAGI (Modified Adjusted Gross Income). Its computation is ascertained by the Medicaid regulations and IRS (Kominski et al., 2017). Therefore, if one receives SSDI, their benefits must be incorporated as part of their MAGI.
Medicare and Medicaid
The ACA minimized the increasing rates of Medicare payments to providers and decreased compensations to Medicare Advantage programs for six years to reduce the rising healthcare costs. The above-mentioned policy also included stipulations that aimed to improve benefits under Medicare by offering coverage for specific preventive benefits, including colorectal and breast cancer screening, diabetes, and cardiovascular disorders.
The policy also included strategies to close the doughnut hole or coverage gap in the benefits linked to Part D medications (Creedon & Cook, 2016). Furthermore, the ACA initiated significant expansions to broaden the eligibility threshold and increase care accessibility regarding Medicaid.
How the ACA is Trauma-Informed
A significant correlation exists between life trauma and increased mortality risks due to chronic disorders. The ACA was passed as legislation to increase access to quality and affordable health insurance for multiple U.S citizens and the increases in healthcare spending. The statute also provided new noteworthy protections, rights, and benefits, which prevented insurance organizations from denying coverage, subsidized healthcare expenses, and demanded that insurers offer coverage to individuals with underlying conditions.
According to Creedon and Cook (2016), pre-existing illnesses are typically chronic diseases requiring medical interventions in acute, community, and primary care facilities. The ACA’s implementation guaranteed the increased access to healthcare services, particularly by individuals diagnosed with these illnesses. The above-mentioned approach also ensures that healthcare providers attain an in-depth comprehension of deportments that cause chronic disorders.
Life trauma can trigger lifestyle activities, which influence chronic diseases’ onset. Therefore, through increased access, healthcare practitioners can get a comprehensive understanding of previous traumatic occurrences in a patient’s life, which consequently promotes the provision of appropriate care and better health outcomes.
How the ACA Promotes Human Rights
The ACA promotes human rights by advocating for the entitlement to better health through healthcare access. Following this policy’s implementation, the U.S experienced a surge in the rate of insured people. Employers were also mandated to provide insurance to all their workers. Healthcare access for all individuals, including those with chronic illnesses and mental health conditions, has also increased significantly. The Act further initiated significant modifications in the coverage benefits provided by insurance plans.
The young populace segment is currently eligible for receiving healthcare using their parents’ insurance plans until they attain 26 years. Despite these significant milestones, the policy does not warrant healthcare access to every individual in the U.S. To counter this drawback, legislators can conduct substantial amendments to the policy to ensure that it accommodates every person’s healthcare need, particularly access.
Conclusion
Mental illness relates to an extensive range of psychological health disorders that affects an individual’s behavior, thinking, and mood. The ACA is a U.S public health policy watershed, which was revised by the Health and Education Reconciliation Act. This policy enhances the universal healthcare insurance access, health insurance affordability, as well as care and coverage adequacy.
The ACA plays a crucial role promoting mental health by increasing care access, operational efficiency, and improving patient outcomes. This act supports human rights and is trauma-informed; however, I recommend its amendment to ensure it guarantees healthcare access for all individuals and healthcare expense reductions.
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