When it comes to reopening in the midst of COVID-19, Texas is certainly setting the pace.

On May 18, 2020, Governor Abbott announced the latest phase in his plan to restart the state’s economy, permitting childcare facilities, restaurants, and select other venues to begin operation—albeit at a limited capacity.

The move predictably garnered national attention, with many commentators discussing the potential ramifications of the Governor’s decision and speculating on the physical harm it could cause.

There’s only one problem: by focusing merely on the bodily health of Texans, we are obscuring the bigger picture. In times of crisis, mental health concerns are just as important as physical ones. In Texas alone, nearly 6.5 million people experience  mental illness—and their conditions are all too often exacerbated by the very circumstances the pandemic created. Increased stress, fear, uncertainty, and isolation can wreak havoc on a person’s mental health.

Now, more than ever, individuals with mental illness require every social and financial resource available to them—not just in Texas, but across the nation. Unfortunately, the federal government recently finalized a rule that will make access to financial resources that help patients pay for vital prescription drugs much more difficult to obtain. In an unfortunate turnaround from the year prior, HHS will now allow insurers to exclude vital manufacturer cost-sharing assistance from patients’ annual deductibles or out-of-pocket maximums.

The change will permit insurance companies to expand the use of so-called “accumulator adjustment programs,” health insurance tools that prevent co-pay assistance from counting towards a patient’s out-of-pocket maximum. As a result, patients who rely on expensive prescription medication will end up paying a substantial premium to acquire the drugs they need to thrive. As insurers begin expanding the use of accumulator adjustment programs, patients suffering from chronic but manageable conditions could face massive surprise pharmaceutical bills totaling thousands of dollars.

Faced with these unexpected, unwelcome costs, many patients may be forced to abandon their prescriptions entirely, forgoing their health to keep money in their bank account and food on their table. Effectively, the change in policy incentivizes people to skip out on taking their medications—and this reality is disastrous for those suffering from mental illness.

As it stands, Americans combatting mental illness already face a greater risk of medication nonadherence. Our government policy and insurance programs should attempt to make it easy for people to adhere to their prescription medications. But by erecting additional financial hurdles, accumulator adjustment programs are only making it more difficult for people living with mental illness to receive the treatment they require.

Ultimately, accumulator adjustment programs are disastrous for all parties involved. Not only do they sour relations between patients and the insurance companies, but they also lead to lower standards of care and poorer healthcare outcomes. Far more than the reopening of businesses in Texas, accumulator adjustment programs are an enormous threat to the mental health of all Americans—they should be banned from health plans altogether.

Editor’s Note: The above guest column was penned by Greg Hansch, executive director of NAMI Texas. NAMI stands for National Alliance on Mental Illness. It appears in The Rio Grande Guardian with the author’s permission. To reach Hansch, email: [email protected]

Editor’s Note: The main image accompanying the above guest column shows award winners at NAMI Texas’ 2018 gala.


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