Policy Memo: American Healthcare

The Central Issue

Despite the overwhelming prevalence and significance of mental health issues in older adults, the American healthcare system does not adequately cover the services and address the financial concerns related to mental health, resulting in a vastly lower standard of living for the elderly American population. Mental health is the well-being of one’s thinking feeling or mood, and includes conditions such as depression, anxiety disorders, and PTSD (NAMI, 2017). One in every five individuals over the age of 55 have some form of mental health concern (CDC Directors, 2008) and the effect of mental illness can damage one’s life satisfaction, affect physical well-being, and result in a loss of financial and functional independence. To an audience of policymakers, an issue of this scale and importance warrants policy measures that will ensure the accessibility and affordability of mental health care for America’s elders.

Medicare Coverage of Mental Health

Approximately a fifth of Medicare beneficiaries have mental health conditions (CMA, 2013). Medicare plays a vital role in decreasing the financial burden of mental health services by paying eighty percent of the costs for for outpatient mental health services, however this provision is insignificant when many psychiatrists and other physicians do not accept Medicare, thus requiring patients to rely on out-of pocket spending (Barry, 2014). While there is no limit of days of care in a general hospital, Medicare coverage of inpatient care in psychiatric hospitals is limited to 190 days which is detrimental to patients of chronic mental conditions who require long-term care (Barry, 2014). Additionally, due to the “donut hole”, or coverage gap in provisions for drug treatments through Medicare Part D, patients of psychiatric disorders that require long-term medication may not be able to afford treatment (CMA, 2013).

Medicaid Coverage of Mental Health

Medicaid is the largest source of funding for the American healthcare system (NCBH, 2017). Medicaid-covered mental health services include psychiatric hospital visits, psychosocial rehabilitation, and medication management. Elders with mental health concerns may qualify for Medicaid on the basis of low income or disability in the case of a serious mental illness (NCBH, 2017). Twenty percent of dually enrolled beneficiaries, individuals under both Medicare and Medicaid, have some form of mental illness (NCBH, 2017). One of Medicaid’s largest structural issues is that each state has unique guidelines, and around half of the states have not expanded mental health provisions through Medicaid, which leaves many dually enrolled beneficiaries with a lack of access to affordable mental health services (AHP, 2017).

ACA Coverage of Mental Health

Although the Affordable Care Act has made improvements to mental health care services, vast discrepancies remain. The 2008 law implements a plan for gradually reducing the coinsurance that a patient must pay for outpatient mental health treatment from the current share of fifty percent (Barry, 2014). The ACA also improves diagnosis of depression, which is often underdiagnosed due to assumptions that depressive symptoms are part of normal aging, by offering free yearly screenings of depression at no cost to beneficiaries (CMA, 2013). The legislation included the guideline that mental health care services had to be as easily accessible as physical health services, an action that lessens the impact of the stigmas against mental health. 

Policy Recommendation and Political Risks

In order to provide affordable and accessible mental health services for America’s elders, a policy of increased federal financial support and incentives for mental health care should be implemented. This policy includes (1) federal guidelines for mental health care services that apply across all states and are on par with physical health care services, (2) financial incentives for mental health providers who accept Medicare and Medicaid, and (3) a gradual plan of increasing the federal funds for  long-term care and drug treatment that is required of patients with chronic health conditions. If this policy is implemented, the American health care system can address the needs of elders with mental health concerns with greater efficacy and financial stability.

Despite the difficulty of expanding mental health services within the current political environment in which Republicans are calling for less funds to health care and other entitlement programs, there are significant political risks if this policy is not implemented (AHP, 2017). The elderly population is large and holds an increasing amount of political clout. Thus, this policy that benefits their health, life satisfaction, and financial status is sure to have a large amount of popular support while failing to implement this policy will result in alienation from a large portion of the voting bloc. 

Mental health has long been an underfunded, underdiagnosed, and overlooked aspect of American health care. If policymakers agree to implement a policy of federal financial support, this issue can largely be averted in the future.

References

Alliance for Health Policy (AHP). (2017). Chapter 8 – Mental Health and Substance Abuse . Retrieved from http://www.allhealthpolicy.org/sourcebook/mental-health-and-substance-abuse/ 

Barry, P., (2014) . Medicare Coverage for Mental Health Services. Retrieved from https://www.aarp.org/health/medicare-insurance/info-02-2009/ask_ms_medicare_question_45.html 

Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. (2008) . The State of Mental Health and Aging in America. Atlanta, GA: CDC Directors

Center for Medicare Advocacy (CMA) . (2013) . Medicare and Mental Health . Retrieved from http://www.medicareadvocacy.org/medicare-and-mental-health/ 

NAMI. (2017) . Mental Health Conditions. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions

National Council for Behavioral Health (NCBH). (2017) . Medicaid . Retrieved from https://www.thenationalcouncil.org/topics/medicaid/