This is part II of a two part series on the impact of the Affordable Care Act and where employee assistance/wellness may have a place in the discussion.

Known Solutions

One of the most compelling bodies of research for providing coverage for all comes from the mental health sector in the form of Employee Assistance Programs (EAP) that are offered by almost all of the largest employers in the country. EAP’s typically offer free counseling or psychotherapy sessions to anyone in the employee’s household. This reduces the barriers to access (such as co-pays, deductibles) and allows for earlier intervention. The medical cost offset literature is very clear that as co-pays go up, individuals with chronic illnesses and limited income such as those that may be enrolled in Medicaid programs defer purchasing medication even though not taking the medication eventually will result in serious medical complications. Having no insurance will increase the probability even further that “healthy” individuals will be even less likely to seek medical care than other populations when they need it because of the barriers to access, thus driving up costs in the public sector, or contributing to medical bankruptcies when treatable illnesses become complicated later in the course of the illness.

Beside early access and cost reduction, the future of our health as a country lies in proactive wellbeing interventions. As one of the most obese countries in the world due to our over-reliance on processed foods, high carbohydrate diets, and excess animal protein consumption, our medical costs are only going to continue to sky rocket unless we start applying what we know from the behavioral health research related to adherence and relapse on health behavior. Using wellness coaching to modify health beliefs, food choices, exercise adherence, and other healthy behaviors will not only save lives, it will improve the quality of life for all of those in the community. The Social Psychology of health research indicates that “your friends’ friends make you fat.” The converse is also true; they can also make you healthy.

If that’s not enough…

We also know from the literature that simply being healthy does not exist in a vacuum and that, in fact, just because one happens to be healthy now, does not preclude them from treatment planning.  Healthy people need to exercise, they need to choose whole and nutritious foods, and they need skills development to help them affect cohorts in the workplace.  The idea that has been put forward that suggests that healthy people don’t need insurance, or more precisely, don’t need to engage in the healthcare market, ignores the continuum of health.  We don’t innately become or stay healthy, that comes from behavioral decisions, influenced or bolstered by our social networks.  Therefore, every person we enroll in a healthcare plan leads to 2nd and 3rd link solutions for others within the network.


The return on investment for the individual, the employer, and society is significant. For example, EAP’s have been shown to return $4.00 to $22.00 per employee per month. The difference between these two numbers is largely due to the panoply of programs available and the ways in which these proactive programs are promoted. The medical cost offset literature for treatment of co-morbid mental health diagnoses and medical conditions would more than pay for the cost of the premiums to the individual. The savings to the U.S. government (thus its citizens) of not having to bail out the insurance companies would be in the 100’s of billions.


There is precedent that even though we as U.S. citizens have our civil liberties (which have been seriously compromised in the last ten years) and freedom of choice, in some cases those choices are limited because of the negative impact on the community. For example, drug testing to ensure safer work places, lowered speed limits in school areas, and even paying into the Social Security system are all ways that we, as a community, have come together to make a decision for the benefit of all. Having a fully-insured population for this country falls into the same societal good ethics argument and this is what makes our country great!

Robert A. Mines, Ph.D.
CEO & Psychologist

Ryan Lucas