Don't Let Trumpscare Unravel Mental Health and Substance Use Treatment Under ACA

By: Debbie Plotnick

As Vice President for Mental Health and Systems Advocacy at Mental Health America it’s my job to work to change hearts, minds, and especially policy.  As I think about where we’ve been regarding access to mental health and substance use disorder (MH/SUD) treatment, I see unprecedented (although maybe not perfect) successes that have happened over the last few years. The Affordable Care Act (ACA), or it’s more commonly known as Obamacare, is (without hyperbole) the best thing to happen to access to mental health and substance use disorder treatment and services in history. It’s also pretty terrific for most people, especially considering that at some point we’re all going to experience the dreaded “pre-existing condition.”

I’ve just made a pretty big claim. But let me offer some context, regarding MH/SUD, and I think you will agree about what we’ve gained under the ACA, and what must not be lost.

The Affordable Care Act (ACA):

• Has made mental health and substance use disorder (MH/SUD) an Essential Health Benefit (EHB) that must be coved in plans in the health insurance market places; in individual, small group and large group insurance plans; and in Medicaid.
• Through regulations the ACA has put forth in 2010 and 2013, regulations that have strengthened parity for MH/SUD services—so that it’s clear that plans can’t exclude MH/SUD treatment, have fewer MH/SUD benefits, limit or charge more for MH/SUD treatment.
• It keeps young people on family insurance plans though age 26, so that they have insurance coverage when they are most likely to start showing signs of a mental health condition, and when early intervention may be most effective.
• In states with Medicaid expansion, the ACA allows low income people, many of whom have mental health needs (estimated to be about 30%) to access Medicaid, which offers some of the most comprehensive MH/SUD services.
• For people with serious mental health issues who even if they previously have been able to get mental health care through state or county services -  the ACA allows them to meet all of their health care needs through Medicaid expansion, which are likely to include other chronic co-occurring illnesses.
• Allows people with preexisting conditions, a high percentage of which are MH/SUD needs, to no longer be excluded from obtaining insurance coverage.

All of this is at risk under the proposed American Health Care Act (AHCA), or what we’re calling Trumpscare! Let me tell you, I’m really scared. I’m scared that public and private insurance plans will, with or without people realizing it, exclude MH/SUD services, and once again make obtaining health care coverage financially unattainable for many of our nation’s citizens.

In the name of “choice,” and “not having the government tell people what their insurance must cover,” the bill of goods called the ACHA puts the gains made through the ACA at risk. What’s really insidious is that these steps backwards may not affect everyone, at least not all at once. Yes, young people may stay on their parents insurance plans, but employers and individuals will be able to purchase plans (whether they realize it or not) that don’t cover MH/SUD services. Medicaid plans by law would no longer have to cover MH/SUD. And people with pre-existing conditions (which means a MH/SUD need) would be able to purchase insurance through the failed concept of “high-risk pools,” which puts costs out of reach for most people.

And if, (a very important word) insurance plans, and state Medicaid plans, do choose to provide MH/SUD services, those services still would have to be covered at parity. But under the complexities of the AHCA, there would be lots of places for people to lose, or to not be able to afford, any coverage at all. The Congressional Budget Office (CBO) estimates that 10 million people would lose their insurance coverage next year, and that 24 million more people would become uninsured in ten years.

A lot of the messaging out of Washington tells folks that the AHCA will allow people CHOICE and will save money. While it’s true that over the long-term, dollars could be saved, it is also true that costs will surely be shifted to the states, and when it comes MH/SUD monetary and life-outcome costs, the expense will be largely borne by individuals and their families. What is being offered under the AHCA isn’t really a fair choice—it’s not really choice at all. It’s a Hobson’s choice! Hobson’s choice is not a choice between one or more options—it’s a choice between something unacceptable, or nothing at all!  For many people, especially those with MH/SUD needs, the AHCA will be a Hobson’s choice.

Please follow this link to contact your House Members and Senators and let them know that you’ve done your homework. Tell them that when they consider the 3-R’s of health care legislation, be it repeal, replace, or reform, they must assure real coverage and not choose to go back to the bad old days!