As the Trump administration continues to undermine and take apart the Affordable Care Act, students are beginning to question how potential changes in federal health care laws may affect their access to both physical and mental health care.
On Oct. 6, the Trump administration announced it would enact a religious exemption for companies and insurers that have religious objections to covering contraception costs in their health care plans. And on Oct. 12, President Trump signed an executive order making association health plans and short-term health plans accessible to more people. This could make "cheaper plans with skimpier benefits more available," with the result of creating "more loopholes for more people to buy insurance outside the health care law’s markets," reported Vox.com.
These attempts to deconstruct the ACA aren't likely to be the last from the Trump administration.
Orders like these place several key aspects of the ACA at risk, such as the ability for individuals to remain on their parents' health care plans until they reach the age of 26, as well as the expansion of Medicaid under the Obama administration, which made mental health care resources available to patients who were not previously able to afford it.
But Trevor Hadley, a professor of psychology in psychiatry at the Perelman School of Medicine, said the Trump administration's recent changes to reproductive care covered by the ACA are unlikely to extend to insurance that protects mental health resources.
While Trump's executive power allows him to change policies surrounding contraceptives, mental health insurance is a fundamental part of the ACA that can not be altered by any action taken by the Executive Branch.
Other bills such as the Mental Health Parity and Addiction Equity Act, passed in 2008 independent of the ACA, provide additional protection to mental health care. The bill links mental health coverage to medical and surgical services coverage and requires that health care plans cover both to the same extent.
On Penn's campus, any federal changes to health care are also unlikely to affect students' access to mental health care because of the structure of student insurance plans.
“Very little of what Penn offers is dependent on the ACA,” Hadley said.
He added that as long as the ACA stays in place without being entirely overhauled, "most people will continue to have mental health insurance.”
Penn requires students to sign up for either public or private health insurance that covers mental health. Penn’s private Penn Student Insurance Plan, which covers 22 percent of undergraduates, 43 percent of graduate students and 51 percent of professional students, also covers mental health care.
Additionally, Counseling and Psychological Services at Penn offers free mental health care that is not dependent on student insurance.
“[Changes are] not going to affect people in the college-age bracket,” Medical School Psychiatry research professor Aileen Rothbard said. “I don’t see that mental health care benefits will be affected right now in any specific way."
"Mental health is not being specifically targeted, like some of the other issues," Rothbard added.
Students at Penn who receive mental health care coverage through the ACA Medicaid expansions, however, might be affected by health care act repeals.
“If Medicaid was repealed along with the rest of ACA, that could be a pretty big blow to mental health care,” Health Care Management assistant professor Atul Gupta said, explaining that Medicaid funds a large portion of mental health care nationally.
Students who receive health care through Medicaid, rather than through the Penn Student Insurance Plan or a parent’s private plan, might see changes in their access to mental health care if any proposed ACA rollbacks are enacted.
Hadley added that in Philadelphia alone, nearly 700,000 individuals receive health care coverage through Medicaid. If rollbacks occur, people on Medicaid will not only lose mental health coverage, but they will lose their coverage entirely.
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