Since there is not much to do, from a layman’s perspective, except wait until June for the Supreme Court to hand down its decision on the Patient Protection and Affordable Care Act (PPACA), I thought I would share some thoughts on how it pertains to young people with chronic mental health problems – the ones who look healthy but actually have considerable healthcare needs.
This is a group that you can define variously depending on what you think constitutes “chronic mental health problems.” I’m going to define it more broadly than traditional definitions of serious mental illness and simply include young adults who have mental health problems so troubling that they seek out long-term mental health services, whether it be medication or any sort of therapy.
I think it’s important to highlight this group because Supreme Court Justice Antonin Scalia (among many others) has argued that the individual mandate forcing everyone to buy insurance is unjust in part because young, healthy people have better things to do with their money besides spending it on health insurance.
I consider this argument flawed for several reasons, not least because young, healthy people could easily get into, say, a serious accident and then taxpayers would be left footing the bill; but there is also a not-insignificant group of people in their 20s and 30s who have ongoing healthcare needs and who do require insurance to meet them.
Many of these people with chronic health conditions, including those who take maintenance medications, fall into this category because they have a mental health condition.
Scalia’s notion of an entire generation of healthy young people is wrong. He would undoubtedly acknowledge that a subset of young people are unhealthy, but, being an older person, he may not appreciate how big this subset is when you include people who are getting or who need mental health treatment.
Many Young People Have Mental Health Problems
According to the federal government’s National Survey on Drug Use and Health, between 24 and 30 percent of people ages 18 to 34 have suffered some kind of mental illness in the past year. According to the same survey, 11 percent of those 18 to 25 and 15 percent of those 26 to 49 received some kind of mental health services in the past year.
Mental Health Problems Are A Significant Expense That Virtually Requires Insurance
Young people have been particularly hit hard by the Great Recession; they were among the first to be laid off, or they were simply not hired at all when they graduated high school or college. Large numbers are unemployed or underemployed, and this is the group with the highest percentage of uninsured.
People of any age who need mental health services generally can’t afford to pay for them out of pocket unless they are independently wealthy, get some kind of discount, or they cut back elsewhere. This is especially true for young people who are just starting out and don’t tend to have much in the way of savings.
I do know of one young guy who doesn’t have insurance and pays out of pocket for his medication, but his parents help pay his medical bills. He doesn’t go to therapy, and he is careful to get only generics.
Furthermore, in many cases, a single, generic psychiatric drug isn’t going to cut it. For many conditions, the standard of care includes both therapy and medications (for some, medications don’t work at all), and you never know when a generic drug might stop working and you might need a brand-name, or when you might need to add another drug to your regimen. (I should add, however, that I do have insurance, and it doesn’t pay for brand-name drugs at all, so insurance is hardly a guarantee of having one’s needs met).
Several Provisions In The Law Would Help People With Chronic Mental Health Needs
PPACA includes a number of provisions that are generally beneficial for those who need mental health care, including mandating that insurance companies cover psychiatric services equally to physical health care services, and making these mental health services part of the basic package of benefits sold in the state-based insurance exchanges the law would create.
Crucially, the law would prohibit insurance companies from denying coverage because of preexisting conditions, including a mental health conditions. I have not personally heard of any young people being denied coverage because they have a history of mental health problems, but there are certainly plenty of insurance horror stories out there.
A secondary hoped-for policy outcome of the law is that it would make insurance cheaper for people with chronic health problems – the idea is that healthier people would subsidize coverage for sicker people.
Young people generally have pretty low premiums because insurance companies consider them healthy and, therefore, low-risk. However, those buying coverage on the individual market – which some have to do if they don’t have full-time jobs, or if they work at jobs that don’t provide coverage -may have to pay higher premiums if they have certain kinds of mental health conditions that insurance companies deem risky, or if they have, for example, an extensive history of suicide attempts or inpatient hospitalizations.
All this is to say that the healthcare reform law is not, in fact, uniformly unfair to young people. It is, in fact, potentially a boon to a very large percentage of them. I wish that Americans, including those with chronic mental health problems, didn’t have to spend so much of their money on healthcare. But I sincerely think this law, if upheld by the Supreme Court, would go at least some of the way toward reducing that burden.