Once again Republicans are pushing to repeal the Affordable Care Act (ACA) and it will hurt millions of Americans, especially those who live with a mental health or substance abuse disorder. The Republican bill would limit access to life-saving Medicaid coverage, make private insurance more expensive, and penalize the poor and elderly — all while reducing taxes on the richest.
The GOP proposal specifically targets Medicaid, the biggest provider of health and behavioral health services in the country, by eliminating the ACA requirement that Medicaid plans cover an Essential Health Benefits package and cutting federal funding by setting a limit for federal reimbursement per enrollee, also known as a “per-capita cap,” no matter their need for care. Weakening coverage requirements and limiting the amount of funding provided to deliver services would hurt the ability to qualify and access Medicaid, especially for those with time-intensive and often costly substance abuse and mental health disorders. Under the GOP plan, a child treated through one of Pacific Clinics school-based mental health programs could potentially lose their Medicare (Medi-Cal) coverage due to budgetary constraints and lose access to care. Many of the children and young adults we see will consider, attempt, or complete suicide. This is the third leading cause of death in children between the ages of 10-14 and second cause of death between ages 15-34.
This bill would also negatively affect those who get their insurance through the Exchanges. In particular, the Republicans’ proposal to eliminate the ACA’s “actuarial value” protections, which require insurance companies to pay a fair share of the cost of your care, would mean higher deductibles and out-of-pocket expenses for low-income individuals. For the millions of Americans seeking care for chronic conditions requiring many doctor visits including mental health disorders, this is simply unacceptable and could make seeing a doctor unaffordable.
Older Americans would also see a big increase in out-of-pocket costs. The GOP plan would allow insurers to increase the “age rating” limits put in place by the ACA and charge older Americans five times as much as they would a younger customer. For the 1 in 5 older Americans who live with a mental health condition, this could mean having to make the difficult decision of going without treatment or going without food.
The Republican proposal comes at a steep cost and delivers little benefit for those seeking either mental or physical health care. According to the Congressional Budget Office (a non-partisan entity), under the GOP plan, 14 million people lose insurance in 2018. It would also cut $880 billion from the Medicaid program, which cares for low-income families and the disabled, while cutting $600 billion in taxes on wealthy individuals.
While some have argued that the ACA did not directly modify the federal mental health parity protections, it did extend those protections to millions of Americans who did not have them before. The ACA also helped millions of Americans obtain health care coverage they would otherwise not have. It is undeniable that the ACA has been successful in connecting more people with behavioral healthcare, especially young adults, children and their families. The law has had a tremendous effect in our home state of California, for example, where one in three Californians currently benefit from our state’s Medicaid program, known as Medi-Cal.
Many challenges still remain for behavioral health — too many individuals do not have access to treatment, there is a shortage of behavioral health clinicians, and the suicide rate, sadly including for children, is increasing. Repealing the ACA and replacing it with the Republican plan would hurt those most in need. We encourage all Republicans to work with us to strengthen the ACA in order to ensure that Americans everywhere have access to the health care they need.
Congresswoman Grace F. Napolitano (CA-32) is Chair of the Congressional Mental Health Caucus. Dr. Luis Garcia is Vice President of Quality Care, Cultural Diversity, and Outcomes at Pacific Clinics.
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