ACA marketplace plans offer limited access to mental health care

Reuters Health - So-called narrow-network insurance plans created by the Affordable Care Act (ACA) offer only limited access to mental health care, a recent U.S. study suggests.

Narrow-network plans, which generally limit coverage to less than 25 percent of health care providers in a given market, were designed to offer lower-cost options for people buying insurance through ACA marketplaces, researchers note in the journal Health Affairs.

But the tradeoff for lower costs may be less access to mental health care - a breach of both the ACA and federal laws requiring parity between coverage for mental health and other types of care.

Overall, narrow network plans included just 24 percent of all primary care providers and only 11 percent of all mental health providers practicing in state marketplaces, the study found.

“The ACA doesn’t specify what constitutes a plan that’s too narrow,” said lead study author Dr. Jane Zhu of the University of Pennsylvania Perelman School of Medicine in Philadelphia.

“And a concern is that a plan that’s too narrow might exclude behavioral health specialists or push people out-of-network, which is associated with higher out-of-pocket costs and may reduce access to care,” Zhu said by email.

For the study, researchers examined data on 531 unique provider networks in the ACA marketplaces in 2016.

Overall, only 43 percent of psychiatrists and just 19 percent of non-physician mental health care providers participated in ACA narrow-network plans, the study found.

The ACA and an earlier law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, aim to make insurance coverage for mental health care as easy to obtain as coverage for physical ailments, researchers note.

The ACA mandates, for example, that all marketplace plans offer coverage for mental health care including treatment for substance abuse.

One limitation of the study is that researchers lacked data on what’s known as behavioral health carve-out plans, which use specialized management firms to provide mental health care separately from physical health care benefits, researchers note. This might mean the study underestimated the number of mental health care providers available to patients in narrow-network plans.

Some of the difference in participation between primary care providers and mental health providers might also reflect a shift in the medical profession that has seen fewer people pursue behavioral health and more individuals choose careers in primary care and family or internal medicine.

In addition, past research has found that both psychiatrists and non-physician mental health care providers face reimbursements for time-intensive care, like talk therapy, that are far lower than their usual rates, so they have incentive to avoid participating in insurance networks, the authors note.

The study also didn’t look at access to social workers, who represent a large proportion of the mental health care workforce.

Even so, the findings highlight a barrier to achieving similar access to both physical and mental health care, the authors conclude.

Before the ACA, less than half of people in the U.S. suffering from mental illness received any care at all, said Benjamin Le Cook, a researcher at Harvard Medical School in Boston who wasn’t involved in the study.

“With the advent of the ACA marketplace, many patients and families that need mental health care have new opportunities for finding affordable insurance that they did not have pre-ACA,” Cook said by email.

“However, this study shows that these families and patients need to shop (for) insurance plans carefully on both price and availability of mental health providers,” Cook added. “It may be worth it to them to pay a higher premium to get a mental health provider that can provide the best treatment for them or their family member.”

SOURCE: Health Affairs, online September 5, 2017.