POLITICO – Millions of Americans, including many struggling with opioid addiction, risk losing access to mental health treatment if Republicans make good on their promise to do away with Obamacare.
Full repeal of the health law would gut major benefits and protections for what HHS estimates is 60 million people with mental illness and substance abuse disorders — creating barriers to treatment at a time when opioid abuse is epidemic, suicide rates are at a record high and there's a severe shortage of psychiatric beds.
The GOP's drive towards repeal comes after a handful of Republicans from states hit hard by the opioid abuse epidemic like Sens. Rob Portman (Ohio) and Rand Paul (Ky.), made combating substance abuse and expanding access to treatment a pillar of their 2016 campaigns. President-elect Donald Trump also promised to "dramatically expand access to treatment" as part of his plan to combat opioid abuse. All support repeal of the Affordable Care Act.
"The ACA created the largest expansion of mental health and substance use disorder coverage in a generation," said Director of National Drug Control Policy Michael Botticelli during a White House briefing. "It's making a real difference in people’s lives on a daily basis."
Paul Gionfriddo, president of Mental Health America, said full Obamacare repeal "would be akin to Armageddon" for people with mental illness.
One GOP leader on mental health policy, Rep. Tim Murphy (R-Pa.), backs ACA repeal but says he'll push to preserve protections for mental illness in the GOP's replacement plan.
"We'll have some work to do in terms of parity — to maintain that level of coverage for mental health treatment," Murphy told POLITICO. But generally, while ACA replacement plans are in flux and may be for some time, the Republicans have favored less regulation and fewer coverage mandates.
Obamacare included mental health as an "essential benefit" that insurers must cover at the same level as other medical care for the 20 million people covered under the ACA's exchanges and Medicaid expansion. The health law also prohibits coverage denials for people with pre-existing conditions, including mental illness. The uninsured rate for adults with "serious psychological distress" dropped from 28.1 percent in 2012 to 19.5 percent in the beginning of 2015, according to the most recent figures from the CDC.
At the same time as Republicans on Capitol Hill are mapping out repeal plans, Congress is about to pass a three-years-in-the-making bipartisan mental health reform measure, championed by Murphy among others. It doubles down on current parity laws, including ACA protections, authorizes new and existing federal prevention and treatment programs and restructures leadership at the Substance Abuse and Mental Health Services Administration.
The measure, which is part of a larger medical innovation 21st Century Cures bill that easily passed the House and Senate, does not include new funding, though it authorizes $1 billion to fight opioid abuse.
Democrats who worked on passing the bipartisan bill say repealing Obamacare could nullify the legislation's impact.
"If they go ahead and repeal the ACA, all that we’re trying to do here with this mental health bill is essentially going to be meaningless because there's not going to be any coverage for mental health care," said Rep. Frank Pallone, the ranking Democrat on the House Energy and Commerce Committee. "This is a great bill and we worked on it a lot, but it's not going to be worth much if we repeal the Affordable Care Act."
Most Republican replacement ideas floated call for fewer government mandates. House Speaker Paul Ryan's 37-page health care blueprint does not address mental health, although, according to a recent study published in Health Affairs, treatment costs the country more than $200 billion a year.
President-elect Trump has said he is open to preserving the ACA provision banning insurers from denying coverage for pre-existing conditions, but doing so without a mandate to keep healthy people in insurance risk pools is likely to send premiums soaring.
An existing parity law that applies to people getting insurance through their employer would remain intact under Obamacare repeal, but people on Medicaid and in the individual market would lose those protections.
"Emergency rooms better start staffing up because their psychiatric units are going to be overflowing," Sen. Chris Murphy (D-Conn.) told POLITICO.
Democrats who have been working on mental health reform for decades say they are still committed to trying to preserve the ACA's protections for people with mental illness.
Asked if she will work with Republicans on a replacement plan to keep mental health parity, Sen. Debbie Stabenow (D-Mich.) said "I'm absolutely going to do everything I can. But the first thing I'm going to do is try to stop repeal."