There are 3 specific ways Obamacare negatively affects mental health care. It is proving to be true in Massachusetts and I am afraid with full implementation of Obamacare it will be true all over the country.
Psychotherapist Dr. Karen Ruskin says; “if my experience practicing in Massachusetts is any guide, the public should be very skeptical” – in response to Obamacare. As a Psychotherapist, I am concerned for my clients and for the mental health care industry, as I see before me the ways in which Obamacare negatively affects mental health care. There were those who thought mental health and wellness was an important piece of Obamacare and that the added coverage was going to help the masses. Specifically, there were those who believed that the very notion that everyone would receive insurance coverage for mental health care would increase the chances that people would seek out help when they need it. My experience practicing in Massachusetts says differently. As a psychotherapist for 20 years, and business owner of a busy mental health/wellness counseling practice that serves all populations, I see first-hand how, if Massachusetts is any guide, Obamacare will negatively impact client access to services, the individual clinicians practices, and the field of mental health/wellness overall.
“There is a disturbing concerning problem of which clientele are facing with the changing landscape of the mental health and wellness industry that must not be ignored”. –Dr. Karen Ruskin
Provided below are the 3 ways in which I foresee Obamacare directly, and I would argue, negatively, affecting mental health care.
- The poor and middle class, meaning anyone on a tight budget, will decrease seeking out mental health care help. Out of pocket fees are becoming just too darned expensive.
As we approach full implementation of Obamacare, deductibles are rising and co-pays are doubling and tripling. Co-pays just a short time ago which were $10 and $20 per office visit are now rising to $25 and $40 per office visit. Deductibles which were often $0, $250, or $500 are now $3,000 to $6,000. This in effect is causing the people who need metal health and substance abuse counseling the most to forgo it due to the out of pocket expenses which they can not afford. It is just not feasible when you have a child with a behavioral problem, or you have a mental illness, or marital conflict to pay $40 per week for counseling, that equates to as much as $160 per month, for as little as 4 sessions of counseling. I am also seeing people with HMO plans similar to what is being proposed for sale on the Obamacare exchanges limiting sessions so that you have used up your allotted number of office visits before your insurance deductible is even met. The notion of everyone having mental health coverage is amazing, in theory. I wish for everyone to have affordable mental health coverage, regretfully and painfully that is not what Obamacare is.
- For those of you who do seek out help, your options for quality and timely care dramatically decreases due to limited options.
People forced/pushed onto exchange plans to get their insurance including mental health care coverage – while this sounded great in theory- that everyone gets health care coverage, is far from great. Reimbursement rates for clinicians are expected to continue to decline and many of the best therapists are dropping out of insurance networks.
Due to decreasing reimbursement rates, the longer waiting periods for payment, and the additional costs to operate a practice, there will be a shortage of therapists taking the lower reimbursement rate insurance plans. Again, I see it here in Massachusetts. Clients with Mass Health, Commonwealth Care, or Network Health call for services reporting they cannot find a therapist willing to accept their insurance. Clinicians cannot afford to accept the lower reimbursement rates or wait the extended times to get paid. Not because they are money hungry grubs, rather because they truly cannot afford to take them if they are to feed their children, provide for their families, and make a living.
So, where does that leave you, the client? Quality Care: the experienced therapist who has a solid reputation and is able to build a practice of private pay clients will survive. Clients with the plans with the lowest reimbursement rates will have limited options. They will have to choose from therapists with limited experience and/or lesser reputations and long waits for care.
Reality scenario example; currently, prior to full implementation of Obamacare, many therapists accepted clients at a lower fee or accepted lower reimbursement rates because they were able to maintain a mix of full pay- private pay clients that helped to subsidize the lower paying clients. Post Obamacare implementation I am concerned that clinicians will no-longer be able to afford to accept lower fee clients. All clients will use insurance benefits and the full fee – private pay clients will disappear. We are already seeing this in Massachusetts. My concern with Obamacare is that therapists can no longer serve the less fortunate. Therapists cannot serve the clients that have the lower paying insurance plans and still meet their personal financial obligations.
- Mental health professionals (psychiatrists, psychologists, psychotherapists, marriage/family therapists, social workers…) are affected in terms of the way they do business. What I predict will happen is that the private mental health care industry will change – not for the better for the public.
This is just my speculation, I do not have a crystal ball, this is based on what I am seeing before my eyes. I predict that the private mental health care industry will change. My concern is, not in a way that is of value for the client. Not in a way that benefits the client, and rather in a way that is not beneficial. Provided are the 2 private mental health care practice layouts I see.
First, there will be mental health practitioners who will be forced to drop out of insurance networks altogether. Thus, I see the business model that clientele have become accustomed to with mental health practitioners, changing from one in which insurance providers paid clinicians, to rather one where clients pay for services and look to get reimbursed by their insurance providers. Thus, clients will be responsible for the clinician’s fees at the time of service. This will be an added financial hardship for the client.
The second type of private mental health practice option for clientele who are able to find a therapist who accepts their insurance (for those clients who can afford the deductible and once the deductible is met are able to afford the co-pay) is a large group practice. It is costly to meet the expenses associated with new regulations. Which is just but another challenge for those mental health practitioners who are unable to sustain a private practice in the first scenario, leading them to flock to join a large group practice. Newer therapists in the industry who have not built a name for themselves, those who don’t have time for marketing, or are either unskilled at marketing themselves or don’t have the financial means to do so, therapists whose main clientele base is the poor and/or middle class, and quite frankly- many therapists as skilled clinically as they are would be unable to house a practice of only private pay. Thus, ultimately many therapists will have to join a large group practice. Joining a large group where costs are shared will make it possible for the therapist to continue to do what they love – help people.
The problem I foresee is the wait-list clientele will endure in that scenario. The desire and need for a timely appointment when in crisis will not be able to be accommodated, as the numbers of clientele who will seek out the large group will out weigh the numbers who can afford to pay privately in the first scenario. As the majority of the population are struggling financially. Thus, my concern remains that the poor, the middle class, and those on a tight budget may have mental health insurance- but that does not help them if they cannot use their mental health insurance. To not be able to receive services from the experienced specialist they wish to see because they cannot afford to pay out of pocket is devastating. Or, to have to wait for services for yourself or a family member while mental health declines dramatically is also devastating.
Real Case Scenario:
If you found this blog article interesting, and you wish to read a real case scenario for further clarification, check out my blog article entitled: High Co-Pays, High Deductibles, Low Reimbursement Rates – This Is Our Reality.