The Patient Protection and Affordable Care Act is the most significant transformation of the American health care system since Medicare and Medicaid. The Affordable care act became law with President Obama's signature on March 23, 2010 (Ppaca and Hcera, Public Laws). Beginning the first year plan and after September 23, 2010, the entire group plan must include certain health plans which are the "Essential Health care benefits".
The Essential Health care benefits include Ambulatory patient services, Emergency services, Hospitalization, Maternity and new born care, Mental health and substance use disorder services, including behavioral health treatment, Prescription drugs, Rehabilitative services, Laboratory, Preventive , wellness, chronic disease management, Pediatric services including vision and care. (Section 1302 (b) Affordable care act).
Historically, mental health patients have found it difficult to find affordable health insurance policies that cover their particular conditions, primarily due to high costs involved in services. This expense does not just include the cost of care, but also the loss on income due to unemployment, expenses for social support, and a range on indirect costs due to chronic disability that begins early in life. According to Agency of Health care research and quality , the cost of Mental health care in the U.S in 2006 is 57.5B$. The Mental Health Parity Act of 1996 and Mental Health Parity and Addiction Equity Act of 2008 have attempted to decrease the economic burden. These efforts have been solidified by PPACA which requires that mental health and substance abuse disorders be afforded parity with other medical conditions (Golmes.M, 2012).
The PPACA mandates that insurance companies must cover mental health and substance use disorders. At the state level, the PPACA will stimulate coverage for services by enrolling individuals with mental or substance use disorders in state health insurance exchange programs. PPACA allows state to seek grants for psychiatric emergencies, child and adolescent conditions, and postpartum depression and psychosis. PPACA has a role in increasing prospective payments to hospitals for inpatient services, expanding preventive clinical services through school-based health centers and developing community-based, multidisciplinary teams through state grants for integrating primary care and mental health (Compilation of Patient Protection and Affordable Care Act, 2010).
This mandatory inclusion of mental health services in health care reform will be completely implemented by 2019. When the law is implemented, 3.7 million individuals with severe mental disorders would gain coverage. Nearly 31.2 percent of uninsured with mental disorders would be covered under the Medicaid expansion plan. In 2006, Medicaid covers 12.8 percent of the population with mental health disorders, when this act is implemented, this will be augmented to 24.5 percent. Overall it is estimated PPACA will increase 4.3 million users of which 2.3 million users are Medicaid users and 2 million are privately insured. (Garfiel R.L, Zuvekas H.S,Lave J.R et al., 2011).
In addition to the coverage of elders with mental health disorders, PPACA helps to cover children with mental health problems. It is estimated that 40 to 80 percent of the children with mental health problems do not receive services due to lack of insurance (Kataoka S.H , Zhang L, Wells K.B, 2002). PPACA will require all health plans to compulsorily provide mental and behavioral health services at parity. These benefits provide a great opportunity to reshape children's mental health system in a prevention focused manner. (Kavanagh J.E, Brooks.E, Dougherty.S et al., 2010).
This provision of PPACA is not without loop holes and flaws. According to Mertens.M(2010) , some people namely undocumented immigrants ineligible for assistance, individuals who are exempt from the individual mandate and those who opt to pay penalties rather than carry health coverage will remain uninsured. These people pose a problem for the policy makers to provide essential services for people with mental health care needs. However, the significant improvement in the use and coverage of health care services cannot be denied.
To summarize, the magnitude of implementation of these services will depend on how provisions of the legislation are implemented as well as on the capacity of the mental health system to absorb the increased demand for services (Garfiel R.L, Zuvekas H.S,Lave J.R et al., 2011).
Another important aspect that PPACA mandates is the inclusion of recommended Preventive services. Many of the chronic disease such as heart disease, cancer, diabetes are responsible for 7 of 10 deaths among Americans each year and accounts for 75 percent of the nation's health spending, proper implementation of preventive services can have a huge impact in controlling these diseases. According to Maciosek M.V et al. (2010) find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life-years annually. Increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending.
The high quality preventive care helps Americans stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce costs. And yet, despite the proven benefits of preventive health services, too many Americans go without needed preventive care because of various obstacles. One of the barriers is that the focus of our health care system is on cure rather than prevention (Gostin L.O et al., 2011). For over 50 years, separate goals, methods, and resources have divided public health and health care into divisions (Brandt A.M and Gardner M, 2000). The consequences of these divisions have been an expensive and poorly performing health care system that spurns preventive care in favor of cures oriented interventions (Gostin L.O et al., 2011). Another barrier is that the health care system is too disjointed to allow for uniform availability of preventive services. The jurisdictional divides erected by state lines and the preemption barricade created by the Employee Retirement Income Security Act of 1974 (ERISA), renders impossible the provision of a uniform set of evidence-based preventive services to the U.S. population. The Affordable Care Act preventive services mandate breaks down these obstacles that have precluded the availability of nationwide access to uniform preventive services through individual and group health plans. It essentially is a legislation passed by Congress that will help make prevention affordable and accessible by requiring health plans to cover recommended preventive services without charging a deductible, copayment or
The services that must be covered under the preventive services umbrella fall into three categories; namely Preventive services for women (including pregnant women), Preventive services for children and Preventive services for Adults. The United States Preventive Service Task Force (USPSTF) has recommended the private health insurance plans to require coverage of 45 preventive care services for adults. These services were classified as A or B depending on the extent of net benefits. These private health plans must also cover routine physical examinations and visits, health risk assessments and certain free vaccinations namely Flu, Pneumonia, Hepatitis B (Korda. H, 2011). These recommendations can also be extended to Medicare and Medicaid programs. Both programs should cut patient cost sharing for the recommended preventive services and vaccines.
Health Resources and Services Administration with the American Academy of Pediatrics have developed Bright Future Guidelines which recommends Preventive care for children. These recommendations include services that should be provided by Pediatrician and other Health care professionals to children from birth to age 21. The types of services are Regular pediatric visits, Vision and hearing screening, Development assessment, Immunizations, screening and counseling to address Obesity and help children to improve their chances of becoming healthy adults (Korda.H, 2011).
Mandatory preventive care for women are included under the Task for recommendations and new guidelines being developed by Doctors, Nurses and Scientists. Some of these Preventive services include Mammography screening (film and digital) for all adult women ,Genetic screening and evaluation for the BRCA breast cancer gene, Cervical cancer screening including Pap smears, Sexually transmitted diseases screening including gonorrhea, Chlamydia, syphilis and HIV, Iron-deficiency anemia, bacteriuria, hepatitis B virus and Rh incompatibility screening in pregnant women, Breast-feeding counseling and promotion, Osteoporosis screening (age 60 and older), Counseling women at high risk of breast cancer for chemoprevention.
The new rules which eliminate the cost sharing for preventive services will bring peace of mind to many Americans who delay or skip important Preventive care because of costs. Nationally, Americans use preventive services at about half the recommended rate (Glynn Mc et al., 2003). An estimated 11 million children and 59 million adults have private insurance that does not cover adequately cover immunization. For instance, one study found that the rate of women getting a mammogram went up as much as 9 % when cost-sharing was removed (Solanki G et al., 2000)
According to HHS, It is estimated that 54 million additional Americans would receive preventive services coverage without cost-sharing under PPACA. Preventive services would cause both short and long term benefits. Due to the Preventive services like vaccinations, counseling on smoking cessation could avert 100,000 deaths each year (Woolf S, 2009). Preventive services can also play a major role in work place productivity by decreasing the sickness leaves taken by workers (Davis et al., 2005).
Implementation of the preventive services mandates could generate negative effects. For example it could increase physician workloads while simultaneously decreasing their reimbursement ( Cogan J.A, 2011 ). Even though unintended outcomes can be expected during implementation, it is beyond doubt that by transforming the nation's public and private health care systems into public health delivery vehicles, this preventive services mandate represents a huge step forward towards national health reform (Cogan J.A, 2011).
