Jayne O’Donnell , USA TODAY Published 10:57 a.m. ET March 22, 2017
House Republicans’ Affordable Care Act replacement plan would dramatically change who is eligible for free or low-cost health coverage, which critics fear could drastically slash mental health and addiction coverage, which many people got for the first time under the law.
USA TODAY hosted a Facebook Live with Linda Rosenberg, CEO of the National Council for Behavioral Health and Samuel Hedgepeth, who was able to get treatment for his mental health and substance abuse disorders through the expansion of Medicaid in Maryland. Hedgepeth, who served 10 years in prison for drug-fueled firearm charges, has been sober for seven months thanks to medication and treatment. Rosenberg says the cuts to Medicaid that would result from enactment of the American Health Care Act would lead to more overdose deaths and higher costs due to incarceration and emergency room visits.
Mental health and addiction treatment is among the 10 essential benefits plans purchased on the ACA exchanges must cover and the requirement also includes the plans for Medicaid recipients who gained coverage under the ACA’s expansion of Medicaid.
The Congressional Budget Office estimated recently the earlier version of the American Health Care Act being considered this week in Congress would reduce the number of people with Medicaid by 14 million in 10 years. Under changes released Monday night, states could require able-bodied Medicaid recipients without dependents to work beginning in October. States also could receive Medicaid funding as a lump sum instead of a per capita allotment. The revised bill also would repeal taxes on the wealthy, the insurance industry and others in 2017 instead of 2018.
Medicaid is the single largest payer of mental health and addiction treatment services in the country, paying 25% of all mental health and 20% of all addiction care.
“Many will instead end up homeless, in jail or dead,” says Rosenberg.
Lisa Smith, whose recently published memoir, Girl Walks Out of a Bar, chronicles her former substance abuse, says the proposed cuts to Medicaid coverage and ACA subsidies ” will make life worse or impossible for many people who suffer.”
To those who say, “no one is ever denied care,” she says her addictions masked depressive disorder, which required far more treatment than an emergency room could provide.
By the time she entered treatment about 13 years ago, she was bleeding internally and needed alcohol to go to sleep and alcohol and cocaine to get up in the morning.
“I would not have survived if I did not have access to treatment at the time,” says the Manhattan lawyer who now works in legal marketing.
Smith, who has also written about the effectiveness of medication for her depressive disorder, says she tried to go off her antidepressant about 18 months after getting sober, but called her therapist and said she was just days away from drinking again.
“I firmly believe that if i wasn’t getting continuing care and the medication to stay sober, I would relapse into alcoholism and would be dead,” says Smith.
While limiting Medicaid services for childless adults may adversely affect people who have mental health and/or substance abuse issues, former Republican Senate Finance Committee aide Christopher Condeluci notes that no matter what the House decides, Medicaid coverage would still be available if a person’s condition is considered a disability. He also believes that it would require an act of Congress — not Health and Human Services action — to get rid of the mental health and addiction coverage on its own.
“Also, exceptions could be put into the law which could allow childless adults with these conditions to qualify for Medicaid services if, for example, they enroll in certain programs, like a substance abuse rehabilitation program or some sort of counseling for mental health-related conditions,” says Condeluci. “There are ways to provide assistance to this population.”
On Tuesday, the Urban Institute released a new report that found the limited allotment of federal Medicaid contributions per enrollee as proposed in the AHCA could cut $734 billion in federal and state Medicaid spending between 2019 and 2028.
In Ohio, which has been particularly hard hit by the opioid crisis, Gov. John Kasich’s administration projected the state would have to raise its spending by $7.8 billion over eight years to keep its expansion of Medicaid under the ACA. And if the state repealed its expansion, 750,000 people would lose Medicaid, most of whom would end up uninsured. Ohio also projects that its overall Medicaid program would exceed its per capita cap allotments by 2025, forcing the state to cover all costs above the cap or curtail services to children, seniors, and people with disabilities, according to a state roundup out this week by the Center on Budget and Policy Priorities.