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Despite ACA, Not All Insurance Provides Mental Health Care

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One in five Americans suffers from some form of mental illness, according to the National Institute for Mental Health.

Even more are estimated to wrestle with short-term depression and anxiety.

Most Americans assume their health insurance plan will cover therapy and prescription drugs. Unfortunately, that may not be the case.

Two types of health care coverage are not required to provide mental health benefits under the Patient Protection and Affordable Care Act (ACA).

The first is grandfathered insurance policies.

When the ACA went into law on March 23, 2010, it allowed employers to keep their current health care coverage.

These pre-ACA policies are not required to provide the 10 essential benefits of the ACA, most notably coverage for preventive care, contraceptives and mental health.

In order to maintain grandfather status, a plan cannot eliminate benefits, increase cost sharing or significantly change co-pays.

A 2018 Kaiser Family foundation report revealed about 20% of firms still offer at least one grandfathered policy.

The appeal of these policies falls into two categories.

The first is cost savings. By not providing all of the essential benefits of the ACA, the plan reduces its financial obligation. This line of thought has changed recently in that the prohibition against significantly increasing premiums or co-pays makes these plans less affordable for employers.

The other benefit is the ability to avoid providing controversial services. This is seen in faith-based organizations that do not want to fund contraceptives, abortion or substance abuse treatment on moral grounds.

The other type of health care plan that does not fall under the rules of the ACA are health care cost-sharing ministries.

These are faith-based, nonprofit organizations designed to function as a community for the purpose of sharing health care costs.

The best known are Samaritan Ministries, Medi-Share and Christian Healthcare Ministries.

These plans provide services to around a million Americans and date back to the 1990s when many clergy and self-employed workers had trouble acquiring affordable insurance.

Their members are allowed to be exempt from the ACA’s individual mandate clause.

The advantages of these plans range from price point to being part of a like-minded community to having a spiritual element involved in the health care process.

Functionally, it is the members who band together to share each other’s health care burdens both financially and spiritually.

Just like religious groups that still hold grandfathered plans, health care cost-sharing ministries also are not required to fund services in opposition to their moral beliefs.

Like any health care plan, there are negatives. These range from limitations on services like preexisting conditions and mental health coverage to financial caps limiting payouts.

The two largest problems are lack of a guarantee of payment and no regulations.

Because these plans are not traditional insurance, there is no guarantee there will be financing for an individual member’s needs. The funds may not be available.

The other problem is governmental oversight. In 2010, these plans were certified by the Center for Medicare Services. However, because of the repeal of the individual mandate in 2017, they have not been regulated by a governmental agency.

Lack of regulation leaves the members of these plans with no recourse to appeal to a state insurance regulator. All of this has an impact upon the financing of mental health treatment.

While some grandfathered policies still offer mental health coverage, most of these plans do not or offer very little.

Health care cost-sharing ministries that do offer coverage only pay for six months of counseling and prescriptions. Mental illnesses frequently require much more.

One would think that faith groups would be leading the way in treating mental illness, but the response of most health care cost-sharing ministries is not enough.

While the Mental Health Parity and Addiction Equity Act of 2008 and the ACA have both made great strides to provide mental health services for society, the church and faith groups seem to be lagging behind.

Personality and mood disorders continue to be looked down upon in some religious circles.

A prevalent idea still exists that bipolar disorder, schizophrenia and depression are the results of personal sin and therefore something to shame.

The church and clergy were once society’s primary and often only source for mental health services. So why do churches and faith groups not step up and do more for those suffering?

The refusal of some faith-based groups and health care cost-sharing ministries to provide adequate coverage for mental health issues does not help the matter.

The reason these groups decline to provide more mental health coverage is unclear.

What is clear is they frequently deny payments on the grounds of preexisting conditions or by stating that mental health services are not covered.

If these organizations are going to justify holding on to pre-ACA insurance policies or health care cost-sharing ministries on moral and doctrinal grounds, they must also live by and pay for the other dictates of those doctrinal system.

These same faith systems call believers to care for one another. Health care cost-sharing ministries are proud to proclaim they are following a Christian ideal by “carrying each other’s burdens” but they fail to apply that to mental health.

Caring for those who suffer is the ministry of the church, even if the one who suffers has depression or bipolar disorder. Faith-based organizations need to do more than just provide lip service to their ideals.

To be true to their religious convictions, churches and religious organizations should reflect this sentiment in their health insurance choices by providing expanded support for mental illness.

Anything less is just a cost-saving measure, which is below people of faith.

Editor’s note: This article is part of a series this week for Mental Health Awareness Month. The previous articles in the series are:

How Coronavirus Affects Your Mental Health and What You Can Do | Cate Schilling

7 Issues Your Family Must Navigate During COVID-19 Crisis | Kristyn Arnold

Monty Self

Monty Self is the Senior Staff Chaplain and Clinical Ethicist for the Baptist Health Medical Center Little Rock.