Last Thursday, the Senate released the Better Care Reconciliation Act, its proposed replacement to the Affordable Care Act.
While the focus of those who oppose the Affordable Care Act has typically been its higher premiums, the focus of its supporters has been how many received coverage when they were otherwise uninsured.
The ‘otherwise uninsured’ primarily consisted of those with pre-existing conditions, such as high blood pressure or mental illness. Before the Affordable Care Act, someone with a pre-existing condition could be denied coverage or charged more because of their associated “risk.” The Affordable Care Act protected these people and guaranteed them coverage.
The Better Care Reconciliation Act now threatens the insurance of many, including those who struggle with mental illness or addiction.
The Senate bill has a “community rating” provision that does not allow health insurers to charge those with pre-existing conditions more. However, “the Senate’s plan may still propose giving states the power to waive what’s known as essential health benefits. This would allow insurance companies in those areas to exclude certain benefits from their coverage, like mental health or substance use disorder services” (Holmes 2017, p.7).
A study published by the Congressional Budget Office analyzing identical waivers in the House healthcare bill proposed last month predicted that the market would revert to the way it was before the Affordable Care Act, or even worsen. If a state invoked its right to waive essential health benefits (EHBs), “insurers would begin a race to the bottom to provide the most bare bones coverage. Those who provided more comprehensive coverage would attract less healthy customers and see their costs rise accordingly. To avoid this issue, insurers would jettison coverage of expensive treatments and try to cherry-pick only healthier customers” (Berger & Gee 2017, p.4). EHBs are predicted to include both substance abuse and mental health benefits.
According to a study done by the Kaiser Family Foundation, history shows that if insurers had the option to waive EHBs then they would. Before the Affordable Care Act, 45% of plans did not cover out- or inpatient substance use disorder services and 38% did not cover out- or inpatient mental health and behavioral health services (Claxton, Pollitz, Semanskee, & Levitt, 2017).
The Center for American Progress also concluded that, “in states that waived requirements for substance use disorder and mental health benefits, coverage for drug dependence treatment would cost an extra $20,450, and coverage for depression would cost an extra $8,490” (Holmes 2017, p.9).
The Better Care Reconciliation Act is also proposing steep cuts to Medicaid, which is, “the single largest payer for mental health services in the United States and provides coverage for millions of Americans with mental health or substance abuse disorders” (Sifferlin n.d., p.1). The Affordable Care Act granted coverage to significantly more Americans by expanding the program from its previous limitations to specific low-income groups, such as pregnant women and the disabled. Instead it included anyone below 138 percent of the poverty line in the 31 states that opted to participate (Kliff 2017). In the Congressional Budget Office’s aforementioned study, it was projected that the proposed cuts to Medicaid’s expansion would result in, “no additional states expand[ing] Medicaid — and that some current expansion states would drop out of the program, resulting in millions losing coverage” (Kliff 2017 p.17).
The results of leaving mental illness untreated range from the development of chronic physical health problems to job instability, homelessness, incarceration and self-harm that may extend to suicide (Young 2015). Making treatment available for those struggling with mental illness and substance abuse stands to only provide a positive impact for our communities.
For more on this topic, please read, “Senate Health Care Bill May Hurt Mental Health and Addiction.”
Berger, S., & Gee, E. (2017, June 20). Senate Health Care Bill Could Drive Up Coverage Costs for Maternity Care and Mental Health and Substance Use Disorder Treatment. Retrieved June 27, 2017, from https://www.americanprogress.org/issues/healthcare/news/2017/06/20/434670/senate-health-care-bill-drive-coverage-costs-maternity-care-mental-health-substance-use-disorder-treatment/
Claxton, G., Pollitz, K., Semanskee, A., & Levitt, L. (2017, June 14). Would States Eliminate Key Benefits if AHCA Waivers are Enacted? Retrieved June 27, 2017, from http://www.kff.org/health-reform/issue-brief/would-states-eliminate-key-benefits-if-ahca-waivers-are-enacted/
Holmes, L. (2017, June 22). What The Senate Health Care Bill Could Mean For People With Mental Illness. Retrieved June 27, 2017, from http://www.huffingtonpost.com/entry/senate-health-bill-mental-health_us_594aad2ae4b01cdedeffc694
Kliff, S. (2017, June 22). The Senate bill to repeal and replace Obamacare, explained. Retrieved June 27, 2017, from https://www.vox.com/policy-and-politics/2017/6/22/15846728/senate-plan-better-care-reconciliation-act
Sifferlin, A. (n.d.). Senate Health Care Bill May Hurt Mental Health and Addiction. Retrieved June 27, 2017, from http://time.com/4829381/senate-health-care-bill-mental-health-insurance/
Young, J. (2015, December 30). Untreated Mental Illness. Retrieved June 27, 2017, from https://www.psychologytoday.com/blog/when-your-adult-child-breaks-your-heart/201512/untreated-mental-illness