With an estimated 30 million people enrolled in the Affordable Care Act (ACA), also known as Obamacare, Americans now have the option to seek medical treatments from a variety of health care providers previously unknown to them.

But it is the coverage provided to those who suffer from mental illnesses that has seen an increase in enrollment in recent years. 

Created and signed by former President Barack Obama in 2010, the ACA allows low-income individuals and families to purchase subsidized health insurance plans through the federal government and helped establish exchanges, or state-run health care markets.

These exchanges authorize private companies like Cigna and UnitedHealth Group to offer a wide variety of plans to individuals and small businesses. Although the beginning stages of the ACA were shaky, the program saw a surge of Americans attempting to find permanent safeguards for their mental health.

“Individuals with […] mental health issues previously struggled to obtain insurance coverage to help them access care,” American Psychiatric Association (APA) President Maria Oquendo and CEO Saul Levin wrote on the APA’s website.

Although it is estimated that 1 in 5 Americans had some mental health condition before the ACA was passed, those who suffered from illnesses such as schizophrenia, bipolar disorder, depression or addiction could not seek the care they needed without being denied enrollment from health insurers or falling subject to mounting premium costs.   

“[The ACA] law changed that by requiring coverage of necessary services to treat mental illness,” Oquendo and Levin wrote. “Consequently, it has become less burdensome for Americans to access appropriate and evidence-based mental health care, thus improving their chance for healthier and more productive lives while reducing the stigma around mental illness.”

In the past, most health care providers only offered coverage for physical illnesses or treatments. The ACA allowed individuals who needed access to long-term treatments the opportunity to explore new resources.

Under the law, health plans can cover the costs of prescription drugs and the practice of medical underwriting, which allowed insurance providers to reject individuals based on pre-existing conditions, was abolished. 

“Insurance companies used to focus on if you had a broken leg or [tonsillitis] … but not so much on mental health,” Joyce Davidson, interim director of Student Counseling Services (SCS), said. “The Affordable Care Act has brought all health and mental health issues into the conscious of people.”

Davidson has worked as the director of Student Counseling Services since 2015, and she has seen her office tackle more than 13,000 student appointments in the last year alone. As a free service for the Iowa State community, that number is expected to rise as the student population continues to grow. 

Davidson said nearly 45 percent of the students who visit her office suffer from depression, while 22 and 23 percent suffer from a form of anxiety or adjustment disorders, respectively.    

Through the ACA, there are a wide variety of resources available to students who suffer from these mental illnesses, but many do not use them.   

“We’re always working on the issue of accessibility and stigma for mental health,” Davidson said. “People worry that it is something that they should be ashamed of or embarrassed about, but of course, they don’t feel that way about getting strep throat.”

Because many mental health illnesses, such as schizophrenia, tend to emerge when people are in their 20s, the need for affordable health care was evident. Nearly 32 percent of young adults, ages 18 to 24, were uninsured in 2010, according to an analysis conducted by the Commonwealth Fund.

By 2014, after the implementation of ACA, that number dwindled to only 18 percent.

“One of things the Affordable Care Act did [was] to allow people to stay on their parents’ insurance until they were 26,” Davidson said. “That was very helpful because sometimes we refer out.”

By allowing young adults, most notably students, to stay on their parent’s plan, the ACA has opened the door for better treatment options for mental illnesses.

This can be crucial, especially when the SCS has the ability to send clients, who may suffer from major illnesses, to outside clinics and services that can better fit their long-term needs. 

Young adults are not the only ones who have benefited from the health care law. In the 19 states that have established a state-, partnered- or federally-run exchange, the ACA has expanded the Medicaid program, allowing low-income individuals and families to benefit from counseling and psychiatric services. The law even allows individuals to undergo preventative health pre-screenings for depression and addiction for free.

But this year the ACA has seen an increase in premium prices. Due to the increase and health care providers leaving state exchanges, discussions of repealing the law under the Trump administration have spawned arguments from dissenting sides of the political spectrum.

Although Iowa has a state-partnership marketplace, has adopted the Medicaid expansion and has accepted millions from the federal government to establish the exchange program, Gov. Terry Branstad has opposed the law and even joined a lawsuit in 2011 that sought to eliminate the ACA entirely.

Both Branstad and Lt. Gov. Kim Reynolds cite increasing premiums as the ACA shortcomings and its looming repeal, as nearly 41,000 Iowans risk losing their current insurance plans as their current provider, Iowa Farmers Bureau, attempts to comply with the ACA’s new regulations by 2018.  

Resources and events available from Student Counseling Services:

First Aid USA: An eight-hour certification course to help communities better understand mental illness and respond to psychiatric emergencies.

When: 5:30 p.m. to 9:30 p.m. Feb. 21 and 22

Where: Room 166 Armory 

Sponsored by ISU Police 

Let’s Talk: An informal drop-in consultation service with counseling staff

When: Walk-in from 3 p.m. to 5 p.m.Monday through Thursday

Where: Reflection Room No. 1, Multicultural Center, Memorial Union

In collaboration with ISU International Students and Scholars Office