Milbank: Falling through Obamacare's cracks
Obamacare expanded health insurance to millions of Americans. But what good is insurance if there are no doctors available to treat them?
This month, I found out, first hand. I saw a woman falling through the cracks of the new health-care system, and I tried to help her.
The woman — let’s call her Isabella — is a naturalized U.S. citizen and housekeeper for a friend of mine. A few weeks ago, Isabella began having what seemed to be debilitating panic attacks. She was unable to work. She stopped eating. She would frequently burst into tears. She said she thought things would be easier if she were dead. She called at all hours asking for advice. During previous episodes, she had gone to the emergency room or paid doctors out of pocket who gave her prescriptions with no counseling for medicines such as Xanax that provided temporary relief at best. She badly needed mental-health treatment — and there was none available.
Obamacare provides mental-health “parity,” meaning mental health is covered as well as any other condition — in theory, an important advance. But in practice, parity was meaningless for Isabella. She is enrolled in one of the CareFirst Blue Cross plans from the Obamacare exchange, but when my friend and I searched for psychiatrists within 30 miles of Washington that take her plan, the CareFirst Web site returned none.
Next, we took Isabella to Metro Immediate & Primary Care, an urgent-care clinic; after a two-hour wait, a doctor said “I can’t do anything for you.” A nurse provided a list of psychiatrists who, we learned after calling them, also didn’t take her insurance.
We tried various other places experts suggested: The 35 K Street Clinic: No good, because Isabella lives in Maryland, not the District. Mary’s Center, a community health-care group, and the Psychiatric Institute of Washington: Both said they weren’t taking new patients. The Women’s Center, a mental-health counseling nonprofit, said the same but offered to put Isabella on a lengthy wait list.
Finally, we found something called Holy Health Care Services, which said Isabella could see a social worker now and a psychiatrist in the middle of next month. With luck, Isabella will get the treatment that she needs — and with more luck, CareFirst will reimburse her for it.
But that’s hardly a reassuring result. Isabella wouldn’t have found psychiatric help without two educated, connected and persistent advocates representing her. (After I made an inquiry for this column, Mary’s Center offered to see Isabella, but we declined.) What if you’re not well-off, well-educated or well-connected and you start hearing voices in your head telling you to shoot people — but you are told by place after place that no doctor is available to see you?
One of those we asked for help with Isabella was my college friend John Santopietro, a psychiatrist who is chief clinical officer for behavioral health in the Carolinas HealthCare System in Charlotte, N.C. He said her experience is typical.
One in five of us needs mental-health treatment at any given time, and for those who get good care, the recovery rate is between 60 percent and 80 percent — higher than in many other medical fields. But only about 40 percent of the people who need treatment get any help, Santopietro said, and those who do “often get bounced around in a system that leaves them feeling misunderstood, stigmatized, brushed aside.”
Obamacare aimed to improve this woeful system by requiring mental-health parity. But psychiatrists, many of whom stopped taking insurance because of the paltry reimbursement, have yet to rejoin the system. This leaves the public mental-health system (clinics that charge on a sliding scale) overloaded.
“What we had is a major expansion of coverage, at least on paper,” said Mark Covall, president of the National Association of Psychiatric Health Systems, a group of 800 mental-health hospitals. But now, “you have insurance but you don’t really have access to these services because these services aren’t readily available.”
Thankfully, a bipartisan group in Congress is trying to fix this. The “Helping Families in Mental Health Crisis Act,” introduced by Rep. (and psychologist) Tim Murphy (R-Pa.)and Rep. (and psychiatric nurse) Eddie Bernice Johnson (D-Tex.), attempts, among other things, to reinforce community mental-health programs. It has 165 co-sponsors and has already cleared a commerce subcommittee. Similar legislation by Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.) attempts to expand the mental-health workforce.
Both could close the gap between what Obamacare promises and what those needing mental-health treatment actually receive.
Dana Milbank is a columnist for The Washington Post.