Take 10: THe Intersections of the ACA and Mental Health Treatment

​The Affordable Care Act has been a hot button topic since it was originally implemented.  You are either for it or you are against it and your feelings about it may be intense. Unfortunately, most of those opinions are not typically founded upon a direct knowledge of the role that it can play in the lives of Americans across our country.  I have sat with friends and family and heard them say that people working minimum wage jobs do not deserve to have health insurance based on their background or education levels and that their employers should not have to foot the bill for minimum wage workers to have healthcare coverage stating that, in essence, someone needs to be at the bottom of the ladder and those people at the bottom are not deserving of the privilege of affordable healthcare coverage.  I have also heard those same people degrade these same Americans for seeking out insurance coverage through Medicaid, calling it a handout, even if these same people are paying the same taxes that everyone else is paying.  When I hear these messages, my mind spins contemplating how people I love and respect, can have such little respect for lives of their fellow humans.  How do we ever break the cycle of the “haves” remaining the only “haves” and the “have nots” always having not if we only maintain a system in which those with privilege are allowed access to affordable healthcare, especially affordable mental healthcare? Maybe that is what these people are actually hoping for, but in my mind, I hope and pray that this is not the case.  Now, don’t get me wrong, I know that the original implementation of the ACA was not perfect or always smooth but the promise of all people being able to have access to affordable healthcare, and for me specifically affordable mental healthcare, felt like such a possibility for larger changes down the road.
 
I can tell you as a therapist, when the ACA was initially implemented it really gave me hope for my clients.  At the time of it going into effect, I had been working in the mental health field for over 7 years and had seen the way our healthcare system was really failing those who were truly most in need.  I saw clients with serious mental illness have to debate between getting a job and being able to continue to have health insurance because their employers did not offer health insurance for them, or if they did it was so expensive they wouldn’t be able to pay their bills if they were to enroll.  How frustrating it was to sit with clients, hour after hour, day after day, week after week, year after year, and hear about how the healthcare system and the government that they were paying taxes to, was failing them.  Some clients would come to therapy, begin medications with their prescriber, and then finally stabilize to the point of being able to work.   Once they started working, they would make too much money for Medicaid and be dropped but also not have access to affordable healthcare at their job.  This would mean they would lose their insurance, decompensate, and lose their jobs and the cycle would begin again.  I would see single mothers, working full time jobs, struggling to make ends meet, but also not being able to take overtime hours because if they made too much money, they would lose their health insurance.  I have sat with clients who have medical debt, which is one of the most common and daunting categories of debt, that feels so insurmountable that their anxiety about debt takes precedent in sessions over other stressors in their lives that we should be focusing our time on.  I sit with clients as they worry that if they get a necessary medical procedure, it may prevent them from being able to pay their mortgage.  I have had clients that thoughtfully mull over the pros and cons of using the health insurance that they pay into for their therapy sessions because they worry about how going to therapy will lead to a mental health diagnosis and that whatever diagnosis they are given will forever be a red letter on their medical file as a pre-existing condition, a pre-existing condition that could mean healthcare coverage would be impossible if certain aspects of the ACA are taken away. Then, as the therapist, sitting with the necessity to make an appropriate diagnosis for a client, knowing that by doing so, I may be affecting important aspects of the client’s future only because they decided to seek out help.  A prime example of this is the rape victim being revictimized by the healthcare system by being strong enough to get help. So many broken aspects of the system that is meant to fix us, inside and out. 
 
I am sure that many of you, unless you have been directly impacted by it, cannot wrap your head around the way in which offering people affordable health insurance can change things and can open doors to things that they never thought were possible.  And, if you have made it this far into this post, I hope you have some willingness to hear me out a bit more.  I thought that it may be helpful for me to share my own story of the ACA and the impact that it has had on my life personally.  My story begins a lot longer ago than you may have anticipated –  in the summer of 1999.  When I was 15 years old, I was the passenger in a pretty horrendous car wreck.  Without getting into too many of the gory details, I broke my back in multiple places, underwent surgery, and also went to mental health treatment in response to the trauma I withstood.  It was a horrific time in my life that made me who I am today and inspired me to be the therapist that has created this platform to explore so many of these topics that are dominating the mental health space we are currently existing in. 
 
From that accident and my physical and emotional injuries, I was left with 2 possible pre-existing conditions.  None of this was my fault, none of this had to do with decisions I made, but here I was with physical and emotional scars that I still have today.  These pre-existing conditions have led to continued medical treatments including additional surgery, therapies, treatments, and at times, medication.  Until the ACA was implemented, I was trapped in a system of being underpaid and burnt out because I needed health insurance.  I was in a relationship with my now husband at the time, but we were not yet married.  And if you have been on this blog journey with me, being independent and self-sufficient was important for me.  Without the ACA, I would never have been able to pursue my dream of being on my own with my own therapy practice.  I remember the years between me striking out on my own, and when I got married, feeling such worries and anxieties about what would happen to me if the ACA was repealed, and how I would be able to continue to do the fulfilling work I was doing as a therapist and still have medical coverage if my pre-existing conditions prevented me from having access to insurance on my own.  I share all of this because having a face to the ACA, a face of someone who has been doing it right, may help to humanize what it can do for people in our country.  I am so thankful for the opportunity to start my own practice and I know that I would never be where and who I am today without feeling secure in my health insurance coverage in order to make the jump into private practice.
 
As I said in my last post, many people may be critical of my decision to become a little political in these posts.  When I think back to last January, when I decided to begin this blogging journey, I had a very long list of therapeutic topics I was ready to write about. But then, 2020 happened, and everything that was no longer is.  What I do on a daily basis has been centered around politics in a way that it has never been before, I feel an obligation to be a voice for the human side of the theoretical topics that are the hot topics in our world.  I am unsure if any minds were changed through this post, but hopefully I have offered some additional enlightenment and maybe opened your minds to the possibility of different ways of looking at things.  To be honest, this post may be a bit more for me, and to help me to process all of the thoughts that are going through my head and heart through this crazy time.  Regardless, I want to thank you for reading and joining me on this journey.