A study published Wednesday in the journal JAMA Psychiatry found that:

1) 55 percent of psychiatrists accepted private insurance, compared with 89 percent of other doctors.

2) 55 percent of psychiatrists accept patients covered by Medicare, against 86 percent for other doctors.

3) 43 percent of psychiatrists accept Medicaid, compared to 73 percent for other doctors.

4) acceptance of insurance has declined among psychiatrists much more than among other doctors.

Reasons for the low participation rate in insurance plans, public and private, include:

–While payments for psychiatrists who provide medication only services are adequate (similar to those of primary care doctors), for psychiatrists who also provide psychotherapy the payments are too low.

–Managed care requirements for psychiatric services are typically more intrusive and burdensome than they are for other specialties; moreover, many psychiatrists practice alone and lack the back office necessary to deal with insurance companies.

–There are too few psychiatrists who have too much demand for their services.

So even though mental health care is one of 10 types of “essential health benefits” that must be provided under the Affordable Care Act and even as parity has ended discriminatory financial policies, the reality is that even having “good” insurance does not guarantee access to psychiatric care. Next year when ACA is implemented, many prospective patients will have less “good” insurance, e.g. Silver and Bronze plans, that will entail high copays and deductibles.

Access to psychiatric care in America is fast becoming both unavailable and unaffordable.