Roosevelt Institute | Cornell University

The Decline in Access to Mental Health care for Low-Income Americans

By Nisma GabobePublished September 29, 2016

There is an increasing lack of access to mental health care for low-income Americans as major insurance companies continue to pull out of Obamacare. Despite the growing problems of suicide and drug overdose in this country, there is a continued disparity between services in mental and medical care, which lowers the health and thus the quality of life prospects of low-income Americans with mental illness as the need for mental care is ignored in favor of medical care.

The Affordable Care Act requires that all insurance plans sold through the federal and state exchanges have mental healthcare and substance use treatment. However, many are still unable to access quality healthcare in these areas, especially compared to the much higher level of access to medical services (i.e. physical care). This problem is exacerbated by the number of major insurance companies pulling out of the marketplace, which leaves the most vulnerable unable to access critical treatment and services.

The National Alliance on Mental Illness (NAMI) reported that regardless of whether an individual has private or federal insurance, there are general barriers to quality mental healthcare and substance use treatment such as: inability to find mental health providers that are also covered by their health plans and the denial of insurers to authorize mental health and substance abuse care.

NAMI found that 26% of people with federal health insurance could not find a therapist or counselor in their plan's network while 22% could not find psychiatrists.
Further, The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 55% of U.S counties do not have any psychiatrists, psychologists or social workers in the area. Aside from the problem of finding a mental health provider within one's insurance, just finding one within one's own area is difficult. Mental Health America's 2016 report found that even in states such as Massachusetts, Maine and Vermont, which have the highest number of mental health providers, there are 250 people seeking treatment for every one provider. In states with the lowest number of providers such as West Virginia, Texas and Alabama, for every provider there are 1,100 people seeking treatment. The situation will worsen for those insured through Obamacare as insurance companies pull out of the exchange because there will be even less of a chance of finding a mental health provider in one's area that is also in one's health plan.

NAMI also reported that for both private and public health insurance, the denial of service for mental healthcare was nearly twice the percentage of denials for medical care. For those with private insurance, 29% reported being denied mental health care compared to the 14% that reported being denied medical care. For those with insurance through the ACA, 16% reported being denied mental healthcare compared to the 9% that reported being denied medical services. The rates of denial were much lower for those with federal health insurance than those with private insurance, but as stated earlier, it is more difficult for those with insurance through the ACA to find mental health providers covered by their insurance to begin with.

According to the American Foundation for Suicide Prevention, suicide is the 10th leading cause of death in the country. The U.S. is also in the midst of a growing opioid overdose epidemic, which killed over 280,000 people in 2014 according to the Centers for Disease Control and Prevention. It is important that we address the difference in services offered in mental care versus medical care as well as the availability of mental care providers and substance abuse treatment to low-income Americans through the ACA. Even if a person of low-income is able to find a provider within their plan, the amount of people who will be limited to that one provider due to insurance companies pulling out of the exchange will lead to poorer quality of treatment and an inability to care for each individual patient. Low-income Americans are unable to pay for health services out of pocket and so they are the most vulnerable in the mental health and substance abuse crisis.