Affordable Mental Health Care: The ACA In My Office

I start with an overview about the Affordable Care Act (ACA), and then shift to seeing it at the level of an solo private mental health practitioner in Seattle.

Change Happened

Over the last six years, the Affordable Care Act has restructured the regulation of health insurance at the Federal level.  It has also expanded the range and depth of most mental & behavioral health benefits. There are new minimum benefit levels that all insurance plans must now include by law.

Permanent Structural Change

The law adjusted elements of Medicare (including its mental health benefits), Medicaid, employer-sponsored and individual insurance plans. Plus, the EDI (electronic data interchange) infrastructure of American healthcare is permanently altered. Changes were made partly so that universal & affordable access to health care, including mental health, could become a feasible national policy goal. It appears to be working.

ACA Here In Seattle

Here in Seattle, the State of Washington developed its own health insurance exchange website, and was among the first to accept the Medicaid expansion allowed by law. It’s easy to see on the site how many more private companies are now competing to manage the benefit. Yes, private sector profit motive still drives the system, but healthcare jobs are growing sustainably to meet the new demand. Competition has clearly increased, and the rates of medical and insurance cost increases are slowing.

Apple Health

Clients With ACA ‘Expanded Medicaid’

This is just a modest attempt to anecdotally note my experience working with the people I’ve seen through the ACA “expanded Medicaid” benefit. The total number of these clients I’ve worked with would not support a full-on demographic analysis.

The clients have been under 40, and either self or part-time employed. These include entrepreneurs, musicians (artists need health care too!), psychotherapists, graduate students, and the recently unemployed.

The ACA Benefit

The clients I’ve seen have benefits which allow for outpatient psychotherapy with no out of pocket cost – neither copayment/coinsurance nor deductible. Typically, that benefit structure is seen by therapists as promoting a decreasing a client’s ‘stake’ in the therapy (client’s commitment to therapy is partially expressed financially).

Yet despite paying nothing out of pocket, I saw them for the same average number of appointments as all other clients. Being freed from any cash costs did not increase client dependence; in effect, people do not act like freeloaders

One Complaint Is Gone

I don’t see the anxiety and occasional terror that was once attached to becoming unemployed. No longer does the personal liberty to change jobs, nor the disappointment of losing one, come tied as strongly to the threat of a personal/family medical cost disaster. Some of the more grievous flaws of the 2010 health insurance industry, which insured health-for-some at ‘off-the-charts’ per capita cost, are beginning to heal.


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