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A recent Facebook post with a hashtag indicating support for U.S. Sen. Bernie Sanders’ presidential bid argued this point in favor of the candidate’s signature healthcare plan, Medicare for All: "Just so we’re clear: people with pre-existing mental health conditions have access to firearms and not healthcare."
This post, which has been shared more than 58,000 times since it was published on Aug. 4, was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.)
First, let’s look at whether people with pre-existing mental health conditions can access guns.
Federal law prohibits the purchase and possession of firearms by people with felony convictions, domestic abusers, and people with specific kinds of mental health histories. The Gun Control Act prohibits transferring a gun to a person who "has been adjudicated as a mental defective or committed to a mental institution," according to the U.S. Bureau of Justice Statistics. Such people are also prohibited from possessing a gun.
The Giffords Law Center to Prevent Gun Violence — which advocates for a more comprehensive system for reporting mental illness and conducting background checks — states on its website that while such checks have blocked more than 3 million people in those categories from getting firearms, federal gun law generally doesn’t affect other people who public health researchers have identified as having a higher risk of being dangerous, including other people who have suffered from severe mental illness.
"The system intended to limit access to firearms for individuals experiencing a mental health crisis still includes dangerous loopholes," the center says.
The law center also points to a 2012 Mother Jones story. It reported that among 62 people accused in mass shootings in recent years, 38 "displayed signs of possible mental health problems prior to the killings." Nearly 80 percent of the perpetrators obtained their weapons legally, according to the publication.
In 2016, the New York Times detailed how people with mental illness are able to get guns. They can buy them from private sellers because federal law doesn’t require background checks for such transactions. Or, they fall under a broader category of mental illness and skirt the restrictions federal law has for people who have been involuntarily committed to a mental hospital or deemed a "mental defective" by a court or other authority. Plus, mental health records are "overwhelmingly under-reported to federal and state databases scanned during a background check," the story says.
So while federal law prohibits people with certain kinds of mental health histories from owning a gun, there are gaps that leave room for people with severe mental illness to buy guns.
Next, let’s look at whether people with pre-existing mental health conditions can’t access health care.
The Affordable Care Act requires health plans in individual and small group markets to cover 10 essential benefits. Among them: mental health and substance use disorder services including behavioral health treatment like counseling and psychotherapy.
"Pre-existing mental and behavioral health conditions are covered, and spending limits aren’t allowed," reads a page on healthcare.gov covering mental health and substance abuse coverage. "Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions."
Other health plans characterized as "short-term, limited duration insurance" — often purchased to fill in coverage gaps such as when a person is between jobs — are not required to include Obamacare’s essential benefits and can exclude pre-existing conditions from coverage or reject people entirely. The Obama administration limited these policies to just three months and regulated them so they couldn’t be renewed, NPR reported in October, but the Trump Administration has changed that; in some states, people can buy such policies that last a year and can renew them twice.
The National Alliance on Mental Illness has decried these short-term plans, saying they discriminate against mental illness. But they’re not sold on the health insurance marketplace and people can’t use federal subsidies to help pay for them. For very healthy people, these plans can be cheaper than what’s available on healthcare.gov, said Linda Blumberg an institute fellow at Health Policy Center at the Urban Institute, but it’s a small segment of the overall insured population.
Job-based coverage from large employers — meaning those with more than 50 employees -— could also limit mental health coverage, Blumberg said.
But since the passage of federal mental health parity laws and the Affordable Care Act, plans that offer mental health benefits must do so in a way comparable to the other medical services they cover.
Today, there are still problems with accessing mental health care, Blumberg said. Some areas have a shortage of providers, for example, or providers who aren’t covered by certain insurance plans. Plus, if the Fifth Circuit Court of Appeals sustains a lower court’s decision to overturn the Affordable Care Act, she said, this Facebook post could be more meaningful.
But with the exception of short-term plans, Blumberg said the claim that people with pre-existing mental health conditions don’t have access to health care isn’t correct.
The Facebook post says people with pre-existing mental health conditions have access to firearms and not health care.
There are gaps in both gun control and health care systems. But the post leaves a misleading impression that anyone with pre-existing mental health conditions can’t get health care coverage when, in reality, it’s only a slice of all health insurance plans that don’t have to comply with federal rules about pre-existing conditions.
We rate this post Half True.
Facebook post, Aug. 4, 2019
Giffords Law Center to Prevent Gun Violence, Categories of prohibited people, visited Nov. 4, 2019
Giffords Law Center to Prevent Gun Violence, Mental health reporting, visited Nov. 4, 2019
U.S. Bureau of Justice Statistics, Background checks for firearm transfers, 2015 - statistical tables, November 2017
Mother Jones, Mass shootings: maybe what we need is a better mental-health policy, Nov. 9, 2012
The New York Times, Why people with mental illness are able to obtain guns, Jan. 6, 2016
Centers for Medicare & Medicaid Services, Information on essential health benefits, visited Nov. 4, 2019
Healthcare.gov, Mental health & substance abuse coverage, visited Nov. 4, 2019
NPR, Buyer beware: new cheaper insurance policies may have big coverage gaps, Oct. 1, 2018
NPR, Open enrollment is here: 6 tips for choosing a health insurance plan, Nov. 1, 2019
National Alliance on Mental Illness, New health plans discriminate against mental illness, Oct. 3, 2018
Interview with Linda Blumberg, institute fellow, Health Policy Center, Urban Institute, Nov. 4, 2019
CMS.gov, The Mental Health Parity and Addiction Equity Act (MHPAEA), accessed Nov. 7, 2019
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