Two steps forward, one step back? Implications of the Supreme Court's health reform ruling for individuals with mental illness

A major promise of the Affordable Care Act is to improve care and financial protection for vulnerable populations such as the many lower-income Americans with mental disorders. The key features of the Affordable Care Act are the expansions of insurance coverage through federally subsidized health insurance exchanges and Medicaid eligibility for all individuals up to 138% of the federal poverty line, coupled with tax penalties for forgoing insurance. Because these insurance expansions are expected to increase coverage for lower-income populations, which have a higher prevalence of mental disorders, individuals with mental illness will see significant gains in insurance coverage and access to care.