May is Mental Health Awareness Month, a time for us to raise our voices about the impact of mental health and critical importance of helping break down the barriers to getting high quality and easily accessible mental health care to those in need. It’s a time to move forward for mental health care, which is why I am especially troubled over the passing of the American Health Care Act (AHCA), aka ‘Trumpcare’, by the House of Representatives.
I have serious concerns about the process by which this bill was passed and its impact of the bill on mental health.
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Process. The bill passed by a slim 217-213 margin with no Democratic support and 20 Republicans voting against. There was very little time for discussion and no time for the non-partisan Congressional Budget Office to score the bill and offer its independent analysis of the bill’s likely economic impact. For a bill that stands to impact one-sixth of the U.S. economy, this in and of itself was legislative malpractice. Moreover, the bill appears to have very little support from the American people. A recent Quinnipiac poll showed that only 17 percent of surveyed Americans were in favor of the bill with 56 percent disapproving of it. In a surprising show of solidarity, most health care organizations (including AARP, AMA, American Association of Pediatrics, and many more) were uncharacteristically unified in their reproach of the bill.
I am among the many healthcare professionals and physicians concerned by the implications of the AHCA on coverage for individuals with mental health issues. There are three main issues at stake:
Mental health and pre-existing conditions
Despite a last ditch provision in the bill ostensibly intended to cover individuals with pre-existing conditions, there is no other way to put it, confidence that there will be basic protections for individuals will pre-existing conditions is gone. In the pre-Obamacare era, insurers had free license to deny coverage. Obamacare enshrined in law protections for individuals with pre-existing conditions, prohibiting insurance companies from denying coverage and, importantly, not allowing insurers to charge significantly higher premiums for these individuals. This bill allows states to waive this requirement. The result may be denials of coverage for those with depression, schizophrenia, bipolar disorder and a host of other mental health conditions. And those that can garner coverage may have to pay more.
Mental health as an essential health benefit
The AHCA removes the requirement that insurers include coverage for benefits that most healthcare providers consider basic services, including but not limited to mental health coverage, emergency services, inpatient care, mammograms, and more. Plans could choose not to cover these services. Plans that do cover these essential benefits may become prohibitively expensive.
Billions in Medicaid cuts threatens mental health coverage
The House bill would effectively roll back Obamacare’s expansion of Medicaid that extended coverage to millions of low-income families. The bill promises to slash $800 billion in federal funds from Medicaid over the next 10 years and move to per capita limits or block grants. Given that Medicaid is the single largest payer of mental health services in the United States, and that more than one-fourth of Medicaid recipients have mental health conditions, cuts to Medicaid equal cuts to mental health coverage.
This legislation as currently drafted is likely to result in a substantial reduction in the number of Americans able to buy affordable health insurance or maintain coverage. Those with mental health issues, some of our most vulnerable citizens, are likely to be the hardest hit. The bill sought to knock the legs out from under Obamacare and if some semblance of this bill passes the Senate, it will have succeeded in doing just that. Despite GOP lawmakers’ best efforts to convince them otherwise, the bill is bad for healthcare, and bad for the American people, with the largest impact on the poor, the vulnerable, and most disenfranchised. This is not what I call health, and it’s definitely not what I call care.
Photo: Professor25, Getty Images
