The Affordable Care Act requires insurers to cover mental health care just as they do physical care, but a new study shows only half of psychiatrists accept insurance. That means access to care for the millions of people with depression, post-traumatic stress disorder and other mental health issues may be limited to those who can pay for treatment out of their own pockets, despite the law.

From 2009 to 2010, 53% of psychiatrists accepted insurance, compared with 89% of all other physicians who did, said Tara Bishop, associate professor of public health and medicine at Cornell Medical College. She looked at data from the National Center for Health Statistics and released her team’s findings in The Journal of the American Medical Association.

“We saw declines in the last few years in rates of acceptance, and we were wondering why,” Bishop said. “I think we’ve all heard a lot of patient stories and doctor stories about trying to find a psychiatrist who takes insurance.”