Often described in such terms as a “revolution” and a “game-changer” for the behavioral health sector in the United States, the Affordable Care Act has helped to enhance coverage for mental health and substance use disorders while encouraging service system innovations at the organizational level. However, tens of millions of Americans still lack health insurance, insurance companies are resisting the implementation of parity coverage rules, and inequalities in the financing and organization of care continue to worsen in key respects. This article examines these difficulties and their political-economic nature, highlighting the need for a single-payer framework if the task of reform is to be fulfilled.
– David A. Rochefort, Northeastern University
