APA Response to Supreme Court Decision on Affordable Care Act

The decision of the U.S. Supreme Court to uphold the Affordable Care Act moves our country forward on the path to extending health coverage to tens of millions of uninsured persons, reducing health care costs and ending discriminatory insurance practices. Since the passage of the act two years ago, millions have benefited from health insurance coverage — including children with pre-existing conditions (including mental disorders), young adults who can now stay on their parents’ health plan until age 26 and older adults via access to prescription drugs at affordable rates. Certain vital preventive services are now covered free of charge by private insurers, as well as by Medicare and a Prevention and Public Health Fund was created. Furthermore, when the state insurance exchanges go into effect in 2014, millions more individuals will have access to health coverage for mental and behavioral health and substance use services as “essential health benefits” and with the same level of access and coverage they enjoy for physical health services. 

The Affordable Care Act recognizes the importance of care that is focused on the whole person and delivered by interdisciplinary, community-based teams of health professionals, including psychologists. Access to mental and behavioral health care offered by psychologists and other qualified health professionals leads to better overall health outcomes. The act also fosters the development of our future health care workforce. These initiatives include support for doctoral, postdoctoral and internship-level training of psychologists in accredited programs, as well as for loan repayment programs for psychologists and other designated health providers in pediatric care and for expanded eligibility for psychologists, psychology programs and psychology students in geriatric education and training programs.

Another significant aspect of the act promotes efforts to eliminate health disparities by first enhancing data collection and quality measure development and then through the adoption of a national strategy to improve the delivery of health care services and patient health outcomes. The Act’s creation of the Patient-Centered Outcomes Research Institute (PCORI) also represents a major contribution to health care quality. PCORI focuses on improving patient- and population-centered outcomes and on helping patients make better-informed treatment decisions.  The contributions of psychologists to PCORI’s work extend beyond establishing evidence-based treatments for mental and substance use disorders to including lifesaving behavioral interventions to prevent and treat chronic health conditions, such as diabetes and cancer.

To realize the core promise of the Affordable Care Act, it is imperative to increase access to care by expanding Medicaid eligibility to uninsured low- to middle-class families. According to the act’s Medicaid expansion provision, those who are newly eligible for Medicaid must receive mental health and substance use services at parity with physical health services. In keeping with the Supreme Court’s ruling, states can now decide to expand Medicaid eligibility and, if they choose not to do so, they no longer face a penalty. Thus, it is now essential to encourage states to expand their Medicaid programs for uninsured persons, while providing access to treatment for mental and behavioral health and substance use disorders, as well as chronic health conditions, by psychologists and other qualified health care providers.