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ACA: Certainty of court's decision gives way to new uncertainties about implementation

July 5, 2012
by Alison Knopf
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Now that we know that ACA is constitutional, new uncertainties about implementation of its key provisions are coming to the fore.

·         Implementing innovative services, and;

·         Substance abuse prevention services.

Because of these findings, NASADAD does not recommend statutory changes to the block grant.


Changing times

In general, expanded insurance coverage via Medicaid and private insurance will mean more premiums for health insurers — an estimated $1 trillion dollars in additional payments from newly-insured Americans between 2013 to 2020, according to Bloomberg —and more patients for behavioral health providers. However, experts also predict that providers will see managed care practices that are more reminiscent of the private sector than the public sector. AHP’s Gauthier says that, among the other implications of the Affordable Care Act for the behavioral health field are these: 

·         Waiting lists will no longer be acceptable.

·         Health information technology will be key.

·         Providers who are willing to assume some financial risk will do well.

·         Behavioral healthcare providers in particular need to be more attuned to financial issues than ever before.


Helping patients

David Guth, CEO of Centerstone (Nashville, Tenn.),says the ACA ruling gave a huge boost to what treatment providers are trying to do – and had already started doing – which is helping patients by coordinating care and focusing on the whole person. “There are so many parts of [the ACA] that are important to us,” he says. “There’s a real focus on health outcomes, better coordination or care, and the elimination of the preexisting condition exclusion, something that plagued folks with serious and persistent mental illness.”

The coverage extension for people up to age 26 is also important because, says Guth, because many serious mental illnesses reach an acute stage during the late teens or young adulthood. “They usually have just aged out of their parents’ insurance, so this coverage extension provision is tremendously important,” he said.

While uncertainty remains as to how states will formulate their essential benefits packages, Guth asserts that there is greater awareness than ever before that mental health services cannot be provided without integration with other medical services. “We have seen the dialogue change in recent years,” he says. “All of us are looking at medical home in a more enlightened way than we were 10 years ago,” he adds, noting. “The medical home should be where the primary problem is.”


From a leader in the public health arena comes this message: good health isn’t only in the “facilities,” it’s in neighborhoods and communities. That is why the Robert Wood Johnson Foundation has, following the ACA ruling, committed resources to help states, communities, nonprofits, and private sector organizations “realize the full potential” of the ACA, said RWJF president and CEO Risa Lavizzo-Mourey, M.D.

“Improving access to stable, affordable health care is not a partisan issue to us,” she said in a statement, adding that the ACA brings the foundation “wonderfully close” to achieving its mission of improving quality health care.

But the law by itself won’t solve everything, she said. “Health care spending continues to rise and crowd out investments in other areas,” she said, noting that even for people with insurance, out-of-pocket costs are so high that the insurance plan itself is a barrier to people seeking help. “Furthermore, our health is not just something that comes from the doctor’s office. Community and neighborhood conditions have a significant effect on health.”

Alison Knopf is a freelance writer.