Improving Access to Health Care: Some Key Protections and Rights

There are key protections under U.S. law and through Federal policy that can be used as tools in the work to prevent and end homelessness through improved access to health care.

Through the Emergency Medical Treatment and Labor Act (EMTALA) of 1986, Americans have the right to receive emergency health care services regardless of their ability to pay. EMTALA ensures the right of all Americans to receive emergency care and imposes specific obligations on hospitals and health care providers to provide that care. This guaranteed access to emergency medical care has been critical to survival for many people experiencing homelessness who have not historically had health coverage or the ability to pay for care.

Access to emergency health care is not access to full and complete health care. For too many people, including those experiencing homelessness, health care entails just one emergency room visit after another without addressing underlying health needs or improving people’s overall health status. Meanwhile, the costs to hospitals and the public increase with repeat emergency room visits. 

The Affordable Care Act of 2010 takes important steps to improving access to more comprehensive health care for most Americans. It expands access to health insurance coverage both by creating private insurance marketplaces and providing States with the option to expand Medicaid coverage to all persons earning at or below 133 percent of the Federal Poverty Level. 

State choice to expand Medicaid coverage under the Affordable Care Act is groundbreaking for millions of low-income Americans and for the effort to prevent and end homelessness. The U.S. Department of Health and Human Services estimates that 1.46 million people have been determined eligible to enroll in Medicaid since October 1, 2013.

“The Affordable Care Act is a vast improvement for millions of people who are homeless or at risk of homelessness,” says John Lozier, Executive Director for the National Health Care for the Homeless Council (NHCHC).

In addition, the Affordable Care Act includes new health coverage rights and protections, making strides to further ensure access to health care in the United States. These include protections against being denied health insurance coverage based on pre-existing conditions, the right to choose any doctor or provider from within one’s health plan network, the right of young adults under 26 years old to be covered under their parent’s plan, and the right to appeal decisions made by private health plan.

Adequate coverage of mental health services is critical to many people experiencing homelessness.  The Affordable Care Act achieves this in part by ensuring that mental health services are covered both by private insurers and by State Medicaid plans. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act fixes the historic disparity in payment for mental health services compared with medical care. 

Passed in 2008, this legislation requires health insurers to pay for mental health or substance abuse care at a comparable rate to payments for physical health care. As a result, insurance companies can no longer arbitrarily limit the number of days patients can spend in the hospital. They are also not allowed to assign higher co-payments or deductibles for persons needing mental health services than they would generally apply to medical services.

Just last month the Federal government issued its final guidance on the Mental Health Parity and Addiction Equity Act, increasing parity between mental health, substance abuse treatment and medical benefits for group and individual health plans, and ensuring that the law will be adequately enforced. These regulations create transparency in benefits and represent a big step forward for patients in guaranteeing that health plans adhere to parity.

“There is no justification for a health plan to impose restrictions on mental illness,” said Andrew Sperling, Director of Federal Legislative Advocacy at the National Alliance of Mental Illness (NAMI).  “Schizophrenia and other psychological disorders are just as devastating to families as diabetes and other medical illnesses.”

Now, “insurance providers must simply cover mental health on the same terms and conditions as any other medical disorder,” said Sperling.

EMTALA, the Affordable Care Act, and the Mental Health and Substance Use Disorder Parity Act all take steps towards access to comprehensive healthcare. Health care availability and quality still varies greatly depending on where people live, and much more work is needed to create a true health care system focused on whole person needs rather than what has been described as a “sick care” system focused on treating illnesses.

As the Federal government, States, the health care industry, and the private sector are now working together to implement the Affordable Care Act, it is possible to envision a day when people with even the most complex and chronic conditions will have access to a full and complete package of health care services regardless of their ability to pay.

To learn more about how the Affordable Care Act, Medicaid expansion, and mental health parity can help end homelessness, please visit the USICH Affordable Care Act page.