Psychiatric care: Longer waits predicted under ACA
New Hampshire residents who sign up for health care coverage under the Obamacare exchange won't have easy access to psychiatric services or other forms of behavioral health care, according to the director of the state's largest private counseling practice.
Evan Greenwald, a psychologist and director of The Counseling Center of Nashua, predicted longer waits in hospitals for psychiatric care and higher suicide rates as the Affordable Care Act puts more insured people into Anthem Blue Cross' narrowly tailored Pathway health plan.
But the spokesman for a non-profit organization that provides behavioral health services in Manchester said he does not expect a surge of patients into the system. If it were to take place, the Mental Health Center of Greater Manchester would hire more counselors because its patients would be able to pay their bills, spokesman Ken Snow said.
Mentally ill people already deal with one backlog in the state's mental health system. People with violent or suicidal tendencies have spent days in hospital emergency rooms waiting for admission to the New Hampshire State Hospital.
Twice this year, those waits turned violent at Elliot Hospital in Manchester, prompting Gov. Maggie Hassan to order a review of the circumstances that led to violent altercations with staff and emergency room psychiatric patients at Elliot Hospital.
Greenwald last week predicted another bottleneck, this one among therapists, psychologists and psychiatrists who treat mentally ill people and try to prevent a hospitalization in the first place.
Pathway, the only health care plan available under the New Hampshire-based exchange, has signed up a limited number of providers and hospitals to its network. A flood of new patients to a small number of providers will mean longer wait times, Greenwald said.
"I think you'll be doing mop-up care, and it will be the emergency rooms in hospitals doing it," said Greenwald, whose practice is not part of the Pathway network. He accepts patients on Anthem's traditional plans, and his patients will lose their therapists if they migrate to Pathway, he said.
Although President Obama last week said he would alter regulations and allow people in the individual market to keep their insurance in 2014, patients who want subsidies still must sign up with Pathway through the exchange.
Greenwald said the Insurance Department should extend a continuity-of-care regulation — which requires an employer to maintain providers for a year when it changes a network — to the Pathway network for the first year.
In an email to the New Hampshire Union Leader, Anthem defended the Pathway network. Anthem was the only insurer selected to provide coverage in the health care exchange, said spokesman Chris Dugan. He said the plan was thoroughly reviewed by state and federal regulators.
Part of that review is whether the network coverage is adequate.
Dugan said that The Counseling Center of Nashua was invited to join Pathway, but it declined. The Counseling Center also does not accept Medicare or Medicaid, Greenwald said. He said his firm can't be viable with the low rates.However, Snow said the Mental Health Center of Greater Manchester can live with Pathway rates. That's because uninsured patients can't pay as it is.
"If more people are paying, there's less of a burden for charitable care for people who can't pay anything," he said.
Obamacare is expected to provide health insurance to 120,000 to 170,000 New Hampshire residents, Greenwald said, citing state Insurance Department estimates. If actuarial tables hold true, between 16,000 and 25,000 of the people newly insured under Obamacare will seek behavioral health services, including psychiatric care, drug and alcohol treatment and other services, Greenwald said.According to his data, the system is already stressed.
It can take four to six weeks for a child to see a therapist at the mental health center in Concord; the wait list for a therapist or psychiatrist is six months in Littleton, according to his research.
It takes one to two weeks to see a therapist at Mental Health Center of Greater Manchester; six to eight weeks to see a psychiatrist there, as well as the mental health center in the Derry-Salem area.
At the Greater Nashua Mental Health Center, a child can wait six weeks to see a therapist, and psychiatric appointments are on average a one-month wait. Greenwald said he found much longer waits, and a lack of providers, in rural areas of the state.
Lisa Kaplan Howe, a policy analyst with New Hampshire Voices for Health, said that while a limited number of hospitals are part of the Pathway network, about 75 percent of providers are in the network. But she said there are regional disparities, and she's spoken to mental health counselors in Nashua who are concerned about the size of the network.
"At the same time we're expanding coverage, we're contracting the network," she said. Howe said the situation should be monitored, and Anthem and regulators should be ready to make adjustments.
She noted that many providers did accept the lower Pathway payment rates.
"Whether they can really afford it, I don't know," Howe said. "Expanding access to coverage is something we all need to be part of."