The Affordable Care Act — At Age 10 How is it Doing Today

During this challenging public health emergency, many people are finding themselves needing health insurance. Congress passed the Affordable Care Act (ACA) ten years ago this spring, and it is now being put to the test of how it is helping the American public. This legislation broadened who could access various forms of health insurance and included measures to control the cost of that insurance.

The ACA included great wins with the introduction of essential health benefits for mental health and prescription drugs. In fact, it is the mental health essential health benefit that makes mental health parity in ACA plans a reality. It increased access to care by offering states the option to expand Medicaid and by providing subsidies for monthly premiums based on one’s income. Of course, as with all legislation, the devil has been in the details, and not all people have fully benefited from the promise of the new law.

With the advent of the COVID-19 crisis, the health care system is now being put to the test. Sadly, millions of Americans are now finding themselves unemployed and scrambling to ensure that they have access to the health care and mental health services they need. While various options are available depending on an individual’s circumstances, DBSA continues to be concerned about the challenges of navigating our complex health care system.

The good news is that because of the ACA many states have expanded their availability of health insurance, either through Medicaid options or state-run health care exchanges. While many of the state exchanges have opened for special enrollment to address those needing health care access, DBSA remains concerned that the federal health care exchanges are not yet open. For more information on what resources are available click here for information.

Your voice can make a difference

DBSA is currently advocating for state and national policies around access to mental health services. As a DBSA advocate, you play an important role in communicating with your state and federal legislators about the important needs in your community. Stay tuned for targeted communications to let them know how your family and others are being impacted and call on them to ensure that access to mental health coverage is seen as a right and not a privilege.

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DBSA Supports Advocates at the State and Local Level

Among the benefits of the ACA was the option for states to expand Medicaid coverage beyond mothers and their children. Thirty-seven states have taken advantage of this policy which has expanded mental health coverage to millions of Americans.

As the leading national peer-directed organization focusing on mood disorders, DBSA applauds this policy as we work to change the conversation around the issue of mental health. We also work with our local chapters and state organizations to support their advocacy efforts in their states. The opportunity to lead a thriving life begins with hope and for many continues with access to quality mental health care that meets individualized needs.

Keeping with our mission, DBSA speaks out in support of opportunities to expand access to mental health care and shares our concerns with policymakers when we learn access is being curtailed. That is why last October we worked with Daisy Jabas, president of the Tennessee State Organization, to submit a letter to the Governor of Tennessee when we learned about plans to restrict access through the state Medicaid program: TennCare. Not only did Tennessee choose not to expand Medicaid as afforded by the ACA which includes mental health services, but they proposed a block grant waiver, or a lump-sum payment, which they can allocate in hopes of saving money, which may further restrict access.

We worked closely with Ms. Jabas, to craft the messaging and provide her the resources she would need to respond. DBSA’s letter outlined concerns about the proposed block grant waiver that could have put coverage at risk for people living with severe and persistent mental health conditions by capping federal Medicaid funding. The block grant proposal could also expose Tennessee to financial risk if per-person costs to TennCare grow substantially faster than expected, as could occur in a public health crisis not unlike the COVID-19 crisis.

Read the letter

Building on a long history of championing personal advocacy, DBSA’s Advocacy in Action program focuses on giving peers across America a voice by placing peers at the forefront in important state and national policies around access, determining needs, and best practices for mental health services. Our goal is ensuring the needs and concerns of peers are front and center in policy, service delivery, and treatment decisions. At its foundation is informing and educating the DBSA community about their mental health parity rights, how state and federal policies can affect access to medical products, and the value of peer support services.

Your voice can make a difference

DBSA advocates have the opportunity to connect directly with policy decision-makers by sending letters like the one we wrote with Daisy. If you are aware of an issue in your state, tell us about it and we’ll work with you to write a letter or comment. You can contact us at

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