Relaxing, Celebrating, & Now Back to Advocating

Why the SCOTUS tossing out California v. Texas is such a relief & where we need to go next

Just after I sent out last week’s post while vacationing with my family, news about the Supreme Court of the United States tossing out the case challenging the constitutionality of the Affordable Care Act, California v. Texas, broke.

California v. Texas being struck down by the SCOTUS is something that all of us here should be celebrating.

Though far from the be-all solution we need, the ACA has done great things for Americans’ mental health – something that was suffering greatly before the pandemic, and that has been greatly exacerbated because of it. More than 150,000 Americans were lost to alcohol, drugs or suicide in 2019, and though only time will really tell, there are early indicators that we could see a significant jump in that annual number next year. May 2019-May 2020, the latter few months of which coincided with Covid-induced lockdowns, marked the largest number of drug overdoses for a 12-month period ever recorded. And even more alarming, compared to the same period in 2019, Emergency Department visits for suspected suicide attempts between Feb. 21 and March 20, 2021 were 50.6 percent higher among 12-17 year-old girls. 

Had SCOTUS overturned the ACA, that decision would have had a devastating impact on mental health in America at arguably the worst-possible time. Why? Well, let’s get into it.


One of the most important ACA protections that California v. Texas put in jeopardy was the provision preventing insurance companies from instituting lifetime limits on behavioral health care. In practice, this allows individuals seeking treatment for mental health issues or substance abuse to do so for as long as is medically necessary. Without it, health insurance plans could limit benefits or treatment plans to a certain dollar amount per year or over the person’s lifetime, imposing a barrier that could keep them from getting the care they need.

Coverage for preexisting conditions – which includes depression, anxiety, bipolar disorder, PTSD and schizophrenia – was another measure under fire. Under the ACA, insurance plans cannot refuse to cover individuals who will require lifelong treatment for mental illness, nor revoke that coverage if they need to use more services.

The ACA also gives states the ability to increase the number people eligible to enroll in Medicaid, which remains the largest payer for mental health and addiction services. It also classifies addiction, mental and behavioral health services as essential, which means all insurance plans are obligated to cover care options such as psychotherapy and counseling, inpatient services and substance abuse treatment. So, if the ACA had been overturned, the definition of “essential services” could have been reevaluated or redefined to exclude mental and behavioral health, leaving too many Americans vulnerable and without access to affordable options for treatment.

Thanks to the ACA, certain preventative services are also covered by all insurance plans at no cost, including depression screening for adults and behavioral health assessments for children. Depression is among the leading causes of disability for individuals 15 years and older, and one in every six children ages 2 through 8 is diagnosed with a mental, behavioral or developmental disorder. 

Early detection and treatment is critical to mitigate long-term impacts – and ultimately save lives. Without the widespread availability and affordability that was just preserved and protected, there would be no way for us to know how many adults and children suffering from mental illness and the lingering impacts of Covid-19 today would continue to go unnoticed and untreated tomorrow.


… remember when I mentioned a few weeks ago that Well Being Trust was working with a mother who had first-hand experience with health insurance and mental health? Carmen Bombeke has created a guide to help parents understand how to navigate the insurance world if and when their child needs mental health care. Take a minute and listen to Carmen tell her story here, and then here, give the guide a read. Even if you don’t have children, you may learn a thing or two about how insurance works.  

Insurance is, indeed, complicated. And when it comes to mental health, part of what makes it so difficult to understand is that there is no consistency between plans on what kind of care is or is not covered. For example, as Health Care Coverage for the Relentless: Insurance essentials from a mother’s quest for mental health parity, explains:

“The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (also known as MHPAEA or the Federal Parity Law) makes it illegal for insurers to discriminate against those with mental illness and/or addiction. The statute aims to ensure equal access to addiction and mental health care as to health care for physical conditions. The law addresses bias in financial requirements, quantitative treatment limitations (QTLs) and non-quantitative treatment limitations (NQTLs). MHPAEA applies to most, but not all, insurance plans ...”

We need to better enforce this federal parity law among the plans that are required to abide by it, and also work to make sure that other health plans are held to the same standard. In addition, we need to make sure that as the conversations about Medicare-for-All-like options are increasingly had, we make sure that Medicare covers mental health and addiction services. Currently, as I wrote with my good friends Dr. Kavita Patel and former U.S. Rep. Patrick J. Kennedy (D-R.I.), “Medicare gets a failing grade for arbitrarily, and detrimentally, limiting much-needed care.”

We’ve had week to celebrate the ACA surviving its third attempt to be struck down. Now, let’s work together to create the integrated, accessible, and community-based mental health system we so desperately need.