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Obamacare’s First Act: Why I’m Optimistic

Obamacare's First Act: Why I'm OptimisticThe dust has begun to settle ever so slightly on the Affordable Care Act (ACA), known popularly as Obamacare, giving us a glimpse at what might be and what has already begun to change in terms of helping some of the most vulnerable among us – people struggling with addictions and mental illness.

As someone who works directly with this population, I am optimistic. It’s still early in the process, but the ACA’s mandated health coverage is having important practical and philosophical effects. In practical terms, more people are getting on the insurance rolls; philosophically, there’s increased recognition that those dealing with mental health issues or substance abuse need and deserve help, and that it benefits all of us when they get it.

Among the bright spots:

The ACA is helping make the most of mental health parity laws.
Passed in 2008, the Mental Health Parity and Addiction Equity Act requires larger group health plans that offer mental health and substance use disorder benefits to provide them at the same levels as medical benefits. It’s been vital in getting help to many, but millions were left out, including those in the individual and small group markets. That changed as of Jan. 1, 2014, when the ACA put into effect its 10 Essential Health Benefits, one of which requires that all new small group and individual market plans include mental health and addiction treatment and that the coverage fulfill the parity act provisions. By building on the parity act foundation, the ACA is expected to extend federal parity protections to 62.5 million Americans.

Teens and young adults are getting help in greater numbers than ever.
Many serious mental disorders and addictions begin in the late teen years and early adulthood. Because youth were traditionally booted from parents’ insurance at age 18 unless they attended college full-time, this meant that many lost coverage just when they needed it most. Under the ACA, offspring can stay on their parents’ policy until age 26. The result is that many more teens and young adults are being seen and getting the help they need, and potentially heading off problems that have the power to destroy lives.

The burden on the medical community is easing.
Emergency rooms are often the first to see people struggling with addiction and mental illness. That’s because the traditional lack of benefits meant individuals had to break down physically before they could access help. Because mental health and substance abuse treatment is considered an essential benefit under the ACA, those in need can now seek help sooner and from those trained to provide it.

The ACA is safeguarding those who have trouble remaining employed.
Traditionally, people who receive health benefits do so through an employer, but those with mental health and substance use disorders often have trouble maintaining consistent employment. Any gap in coverage meant they could be denied coverage due to a pre-existing condition the next time they tried to get on a policy. The ACA has remedied that by eliminating the exclusions for pre-existing conditions.

Gearing Up for Demand

Despite the progress, there are miles to go before the gap is narrowed between the ACA vision for access to mental health and addiction treatment and its reality.

Initially, it is inevitable that the system will be strained, and some individuals may find it difficult to connect with the help they need. This should ease as treatment providers gear up to meet the demand that comes with increased access to benefits.

But perhaps the most important step in the process is getting beyond the stigma surrounding mental illness and addiction. If a helping hand is offered but you dare not reach out and take it, all the laws in the world won’t help.


Obamacare’s First Act: Why I’m Optimistic

David Sack, M.D.

Dr. David Sack is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CMO of Elements Behavioral Health, he oversees a nationwide network of treatment centers including drug and alcohol rehab programs at The Ranch in Tennessee and The Right Step in Texas.

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APA Reference
Sack, D. (2017). Obamacare’s First Act: Why I’m Optimistic. Psych Central. Retrieved on July 8, 2020, from


Last updated: 22 Jun 2017
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