It’s no big surprise that repealing Obamacare will have a hugely negative impact on people who suffer from mental or behavioral illness. But you may be surprised at the scope of the problem.
Who’s Affected?
According to Mental Health America, 1 in 5 American adults have a mental health condition. That’s about 40 million people. Add to that 20 million more people who suffer from substance use disorders and you’re got a whole lot of people who need access to mental and behavioral health services!
For more details, check out these additional facts and numbers about mental illness from the National Alliance for Mental Illness (NAMI) – California.
Every American family, neighborhood and workplace
With so many millions of Americans suffering from mental or behavioral illness, virtually every American family, neighborhood and workplace has been touched. The estimated cost to our economy is nearly $200 billion, but cost cannot just be measured in dollars.
Intersections with homelessness, criminal justice
Part of what makes the impact of mental illness so devastating to individuals and families is that the risk of homelessness, imprisonment and suicide skyrockets when a person develops a mental illness or substance use disorder.
In fact, according to National Alliance for the Mentally Ill (NAMI), 26% of persons living in homeless shelters and 24% of persons in state prisons have some history of mental illness.
Here’s an excellent, shareable infographic on General Mental Health Facts from NAMI that clearly lays out the issues.
A Case in Point: The Opioid Abuse Epidemic
If we just look at one specific and exploding problem, the opioid abuse epidemic, the picture grows darker still. According to the article Repealing The ACA Could Worsen the Opioid Epidemic (Health Affairs, 1/30/17)
The annual cost of the [opioid] epidemic is estimated to be $78.5 billion. In 2014, there were more deaths from opioid and other drug overdose than any other year; 60.9 percent of those overdoses involved an opioid. Every day, an average of 78 Americans die from opioid abuse. The coverage expansions and protections under the ACA can help lessen the epidemic and save lives.
The Nightmare Before Obamacare
According to the American Psychological Association in their recent letter to then President-elect Trump, before Obamacare, insurers used a “wide array of practices to deny, delay and discourage use of [mental health] services.”
These practices included routine denials of coverage in the individual insurance marketplace for people living with depression, bipolar disorder, anxiety and panic disorders, schizophrenia and more.
Check out Terri Carlson’s latest video in which she details the cruel practices typical of the health insurance industry before Obamacare:
And worse, the go-to insurance solution for many people before Obamacare – employer provided group health insurance – was in many cases unavailable to people with mental illness because their condition precluded employment.
Four Ways Obamacare Has Helped
Before Obamacare, according to Dr. Jacob Izenberg, in his 1/23/17 blog, Repealing Obamacare will threaten our mental health (The Hill).
Insurance companies could set arbitrary limits on annual care, exclude behavioral health benefits, or deny coverage altogether.
Obamacare, however, dramatically helped. It increased the number of people with health insurance, improved the quality of insurance policies by banning annual maximum benefits and requiring coverage for mental health services.
Specifically:
1.) For those states that accepted it, Obamacare expanded Medicaid to adults earning up to 138 percent of the poverty level and required that state programs include coverage for substance use disorder treatment. That means that another 26 million people gained access to coverage that they didn’t have before.
2.) Obamacare established Essential Health Benefits that promoted parity between mental/behavioral and physical health benefits. In other words, when it comes to how health insurance responds to treatment, services for mental and behavioral health are treated more like physical health services. Essential Health Benefits were required to be included in employer-provided plans, on- and off-exchange individual plans, Medicaid and Medicare plans beginning in January 2014.
3.) Obamacare offered funding to state Medicaid programs to promote delivery reforms that integrated and coordinated care for individuals with more than one chronic illness, such as diabetes and depression.
4.) The ACA authorized and funded numerous payment and service delivery reforms that enabled states to address substance use disorder in their Medicaid programs. For example, in 2015 California won funding through Obamacare for a five-year demonstration program called Drug Medi-Cal Organized Delivery System. This program integrates the treatment of substance use disorders into both mental health care and primary care.
For more, see this excellent Fact Sheet developed by the California Pan-Ethnic Health Network (CPEHN).
How will repeal hurt Americans?
Repeal will remove treatment and prevention from the health insurance plans of millions of Americans, right when we need it most.
Quoting once again from Dr. Jacob Izenberg’s excellent blog,
“For those who rely on private insurance, the law offers security to people who never previously knew any. For the most seriously mentally ill patients, an expanded Medicaid has become a cornerstone, offering access to quality community-based services that help keep them in the community, and out of hospitals or jails. Now, just as these gains are solidifying, congress (sic) is threatening to undo them by repealing the ACA.
“On the eve of ObamaCare’s (sic) repeal, the mentally ill across the country, regardless of race, gender, or economic status, are vulnerable.”
Medicaid Cutback Nightmare
The GOP’s promised cutbacks to Medicaid will only compound the problem. Again, if we look specifically at the opioid abuse problem, as explained in Health Affairs, 1/30/2017:
Medicaid is the single largest source of coverage and funding for behavioral health services in the country and the ACA has increased access to treatment for opioid use disorder in the Medicaid program in several ways.
Clearly, repealing Obamacare is no solution! It will cause extreme harm to the community of people with mental and/or behavioral health issues.
What should we do instead?
A majority of Americans agree that Improved, Expanded Medicare for All is what we need. With the prospect of an Obamacare repeal looming in our future, now is the time to re-think our options.
Going back to the bad old days is what the GOP Congress is aiming for, and they are completely out of sync with the majority of Americans!
If you agree that California should take the lead with guaranteed healthcare, take action! Join us on Twitter and Facebook, and
Sign our Open Letter to Governor Brown and Our Legislative Leaders!
Dear Governor Brown, Senate President Pro Tem DeLeón and Assembly Speaker Rendon:
Californians need and want guaranteed healthcare that covers everybody for everything for life!
We support the Healthy California Act introduced by Senator Ricardo Lara and co-sponsored by Senator Toni Atkins.
Help all Californians fight the heartless and cruel threats to our healthcare from Washington DC.
Let’s HEAL California with SB 562, the Healthy California Act!