The ACA Repeal and Mental Health
January 13, 2017
Very early Thursday morning the Senate passed a budget resolution to draft a repeal bill, the first step in the process that the GOP is planning to use to repeal the Affordable Care Act. While breathless reporting has declared this to be a vote by the Senate to repeal the ACA, or even more specifically to repeal certain aspects of the ACA, including protections for pre-existing conditions, the advance premium tax credit, and the expansion of Medicaid, along with many others, this is only the first step towards the repeal. The Senate merely passed a budget resolution that did not include proposed amendments that protected those provisions in the ACA from being repealed. There was no reasonable expectation that a GOP majority would ever approve those Democrat-proposed amendments.
The next step in this process to repeal the ACA takes place in the House. The House is expected to pass a budget resolution to draft a repeal bill virtually immediately. After that resolution the House has until January 27 to draft the repeal bill. An amendment proposed by Republican Senator Bob Corker that would have pushed that date back to March 3 initially had bipartisan support, but was withdrawn by Senator Corker, keeping that date, for now, at January 27.
This is what has happened so far. There are still many steps remaining, both in the House and in the Senate, but the ball is rolling and it is rolling quickly towards the repeal of the ACA through the budget reconciliation process. At this point there is no current proposed replacement for the ACA, which makes it difficult to project the precise outcomes of a repeal, and how those outcomes impact mental health coverage. All of the provisions that proposed amendments to the Senate resolution sought to protect could find their way back into a replacement proposal. That is unlikely, but it is still possible. As for now it must be assumed that ACA’s consumer protections for the coverage of pre-existing conditions, as well as the advance premium tax credit, and the expansion of Medicaid, along with many other ACA provisions, will not survive the repeal process.
The lack of protections for pre-existing conditions, along with the lack of the advance premium tax credit and expanded Medicaid, would be catastrophic for the state of mental health in the United States. The primary mechanisms for the ACA’s increase in health care coverage were the advance premium tax credit and the expansion of Medicaid. The advance premium tax credit helped make insurance more affordable for millions of Americans, and the Medicaid expansion covered millions more who would otherwise have fallen through the cracks. A large number of those who receive health care coverage through these two provisions are people who live with mental illness.
Without the advance premium tax credit and expanded Medicaid, roughly 8 million people who live with mental illness will lose their health care coverage. That is an astronomical number. But that is not all. People who live with mental illness will also be severely impacted by the loss of protections for pre-existing conditions. This loss would make the cost of health insurance for people living with mental illness skyrocket, if not making coverage impossible to come by.
There are approximately 57 million Americans who live with mental illness. Every one of them will be negatively impacted by the repeal of the ACA. The ACA’s equal protection provisions, an extension and improvement upon the Mental Health Parity Act, will likely disappear. This will severely harm current mental health coverage. The lack of protections for pre-existing conditions would force even those who do not lose their coverage with the ACA repeal, to remain in their current insurance plan essentially forever. Any lapse in coverage would be catastrophic. The loss of health insurance through an employment change or any other life event would make finding new insurance difficult if not impossible. And there is no way to adequately state how devastating the immediate loss of health care coverage would be for the 8 million people who received coverage through the advance premium tax credit and expanded Medicaid.
Quite simply we cannot allow this to happen. While the repeal of the ACA is underway it is far from over. And while the GOP currently has no specific proposal for a replacement of the ACA, they will eventually have one. There has never been a more important time to advocate for those who live with mental illness.
We encourage everyone who has a voice to use it now. Contact your Representatives. Contact your Senators. Write op-eds. Write letters to the editor. Do anything and everything in your power to let Congress and the public know how horrific the consequences of the current repeal would be without a replacement plan that includes these protections, and many more. Let your voice be heard, loud and clear. And let it be heard today, before it is too late.
Visit this site for information on how to contact your elected officials.