Five days

Industrial lawn mowers mowing.  Making noise.  Assaulting my ears.

Fresh cut grass.  Making dust.  Assaulting my allergies.

People talking.  Making noise.  More assault on my ears.

Now there’s neighbors here.  More talking!!!!  More noise!!!  My ears!!!

Valium on board and useless.

Homesickness assaults my heart.  I miss my husband.  I miss my house.  I miss my quiet.

Oh look, another neighbor!  Holy shit I may tear my ears off.

The talking, the complaining, the ‘nice to meet you’s’ is literally killing me.

Sleep has eluded me for days.  I know that’s a bad thing.  I know that makes this worse.

I know that bipolar and lack of sleep is a shitty combination.  I know it, but I can’t help it.

I take my meds.  I won’t stay asleep.  I suspect it’s the absence of my husband.

Five days ’till hubby.

Five days ’till a solid hug.

Five days ’till someone who understands will stand in front of me and tell me it’s ok.

Five days ’till someone will be the intermediary of these problems.

Five days ’till someone will know the signs of my anxiety and hypomania and depression.

Five days ’till.

Five days.

So what IS Bipolar anyway?

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Yesterday I wrote a post about how people in the mainstream can misunderstand what bipolar is.  But what is bipolar?

The National Institute for Mental Health (NIMH) gives a nice clinical explanation here.

But, how does that explanation translate to what those of us who have bipolar feel on a daily basis?  How does it explain our daily lives?

It doesn’t.

It’s clinical.  And that’s ok.  It should be clinical.  But, it doesn’t describe the true challenges.

I’m medicated.  Heavily in fact.  And, yet, I still experience the symptoms of bipolar on a daily basis. Because I’m treatment resistant, sometimes called medication resistant.  What that means is that my body will not process the necessary medications properly, and either the dosages or the medications themselves have to be changed frequently.

I don’t work.  I can’t work.  A therapist, psychiatrist, forensic psychologist, vocational expert and a judge have all deemed that work is impossible given my limitations.  I am officially disabled according to the Federal Government.  It took two and a half years, but I got there.

I don’t know what I’m going to be experiencing from one day to the next.  I spend a lot of time isolating myself from others, either because I’m too depressed to handle interpersonal interactions, or because I’m incredibly aggravated from the symptoms of hypomania.  Some days depression will keep me in bed all day, even though I’m on antidepressants.  Some days hypomania will have me running around the house at a high rate of speed, partially accomplishing many tasks.

Some days I experience both, in a back and forth pattern.  Some days I experience both at the same time.  Both at the same time is the weirdest feeling in the world.  Tons of energy, tons of irritation and an uncontrollable emptiness all at the same time.

I have experienced mania a few times.  It’s hypomania on speed.  I didn’t eat, I didn’t sleep, I couldn’t stop moving and doing.  I’m grateful that I didn’t experience the very harsh side effects of mania such as overspending and hypersexuality.  But, I also had the outlet of a fast paced, time intensive job and a home that needed work.  I hope to never experience mania again.  I pray every day that my medications will at least keep me from that.

Imagine that you wake up.  You have an incredible amount of energy and it feels so good.  You start working on a project with your spouse that you both want to do and that will be so wonderful when it’s done. In my most recent case this was to get a flower bed planted.  You take to this project with gusto.  But you push yourself way beyond the boundaries of what you are really capable of.  But, you don’t care.  You keep going.  You sweat, but don’t drink water.  You dig, you plant flowers, you constantly move away to make sure that everything is just perfect.  When everything is in, you don’t take the time to appreciate what you’ve accomplished.  You start moving tools that you have no business lifting, because you still have so much energy.  When everything is put away, you still can’t enjoy the fruits of your way overdone labor, because you must start doing something else right away.  Too much energy in your body and it must be expended.  But, at the same time you’re irritated.  The conversation necessary to get this done grates on your nerves.  Other people’s voices make you want to rip your ears off even though you love the people who are talking.

This is hypomania.  Energized, but pissed.

Now imagine after all this is done you suddenly crash.  You still don’t care about the fruits of your labor, because it means nothing to you anymore.  The emptiness swallows you whole.  You can’t talk.  You can barely move, if you’re lucky.  The pretty flowers and the work that it took to make it happen are things that you can’t bring yourself to care about.  All you know now, is that no one cares that you helped.   It doesn’t matter that it looks beautiful.  It’s all going to die anyway.  But, people still want to talk to you.  Of course they do, they love you.  But you can’t care.  The voices still irritate you and as you sit there in a state of desperation and loneliness, and emptiness, you also start to get annoyed again.  Why must they talk about the accomplishment?  Who cares?  You don’t.  Why do they have to keep talking about how pretty it all is?

This is depression.  Emptiness, loneliness and so many untrue thoughts that your brain pushes you into believing all with an absolute crushing lack of energy.

This scenario actually played out with me a couple of weeks ago.  It’s called a mixed episode.  Mine was also accompanied by a heavy load of anxiety.  I don’t know why I was anxious.  There was no reason to be anxious.  There usually isn’t, but I experience it every single day, usually all day.

I’ve been hospitalized for my depression four times in the last six years.  Depression will take you to places that you would never be able to think possible when you are feeling ok.  Depression will make you believe that no one loves you, no one wants you around, you are a terrible burden on those people who are barely tolerating you as it is.  The loneliness sinks in, the lack of energy becomes worse and worse, until you literally can’t get out of bed to do anything but go to the bathroom and even that takes everything you have.  You start to realize that everyone that you love would be better off if you weren’t around.  And you believe this intensely.  And you start to plan.  How best to kill yourself becomes the all consuming part of this severe part of depression.  My plans usually revolve around talking all of my medication, but one time I planned to drive my car into a tree at a high rate of speed.  All of the things that you are thinking, are of course false.  And there is a thread in the middle of this chaos that tells you your brain is bullshitting you.  So far, I have been very lucky to be able to grasp that thread and get help.  Not everyone is so lucky.

This condition used to be referred to as a Nervous Breakdown.  However, often is is now called a Major Depressive Episode.  41,000 people a year commit suicide.  90% of them suffer from mental illness.

As I end this post with the most depressing part, please let me implore you.  If you are asked for help for suicidal thoughts…HELP.  Sit with the person, understanding that you can’t talk their brain out of the false thoughts.  Hold their hand, hug them, whatever they will allow.  Take them to a crisis center or a mental health hospital and get them the help they need.  You can’t fix it, but you can get them to people who can.

National Suicide Prevention Hotline (US) 800-273-TALK (8255)

Peace & Love to all of you

 

 

Misunderstanding Bipolar Disorder

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About 2 weeks ago I told someone I had bipolar disorder.  The response I received was ‘But you seem so intelligent’.

????

Okay.  I replied that bipolar disorder has nothing to do with intelligence but is in fact a mood disorder and is classified as a mental illness.  A couple of questions followed from others in the room and I answered them all to the best of my ability.  I explained that I am, in fact, quite intelligent but I have memory problems due to my medications.  In fact, I explained quite a lot of things.

But, here’s the thing.  Those of us with bipolar disorder are automatically tasked with explaining it.  We hate the stigma.  But the stigma exists because of the lack of understanding in the “normal” population.  And if we don’t explain it, than who will?  No one.  There is no one else in a better position to explain bipolar disorder then those of us who suffer with it.  Of course, that’s ridiculously unfair, because many of us have trouble just making it through the day.  But, it doesn’t matter that it’s unfair.  It is what it is.

I have “come out” a lot recently.  I’ve decided that I don’t care what someone thinks of me because of my bipolar.  If they can’t see past it, then that’s their problem.  Of course, the co-dependency that exists in many of us makes it incredibly difficult to let someone walk away from us because of our disease.  And, of course, it’s ridiculously unfair for someone to do that.  But, I’ve come to realize that it’s a risk, and it’s possible that I will lose people in my life because of it.

So far, so good.

The person who exclaimed that he couldn’t believe it because I seemed so intelligent listened patiently as I explained the broader strokes of bipolar.  And, I’m happy to say that he is not only still in my life, but now has a much better understanding of my condition then he did the day he found out about it.

A lot of the reason that I have decided to speak out about my bipolar is because of the new proposed health care laws.  If you haven’t been keeping up, this is the time to start.  Medicaid recipients stand to lose all mental health benefits if their states ask the Federal Government for a waiver of the “Essential Health Benefits“.  In poor states, like mine, that waiver will almost surely be asked for and granted.

Now, the Senate is working on their own bill, and we don’t really know what it’s going to say yet.  But, I began speaking out for fear of those on Medicaid who are mentally ill.  I have spoken at rallies, I have spoken to the press.  And I will continue to do so.  I’m outing myself publicly to protect those less fortunate than I am.   And, ultimately, to protect myself from hostile stigma that’s sure to be coming my way.

Educate those around you.  If you have the ability, educate your Members of Congress.

Stigma will never go away until those of us with the power to explain the illness actually start standing up and doing so, no matter the cost to personal relationships.  It’s not easy, it’s often extremely difficult.

But it’s so very very important.

 

Love and Peace to you all.

The Bipolar Slur

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I wrote this yesterday in a high hypomanic state.  I left it for a day to see if it would still make sense when my mood wasn’t so elevated.  With a lot of spelling and grammar corrections, it seems to be pretty good to me.  

 

Most people who use the word bipolar as a slur are trying to say that someone’s moods are switching too fast.  But, using is that way is a slur.  It might be a way of describing that someone can’t make up their mind.  It may suggest that a person acts one way in a certain situation and another way in a different situation.  Or it may suggest that a person seems happy one moment and not so much the next moment.  But, bipolar is a very real, very serious mental health diagnosis that causes constant suffering for most of the afflicted.

Since my diagnosis, I have noticed this slur more often.  It’s probably the same thing that pregnant women go through when suddenly it seems like every woman they see is pregnant.  I see this on Facebook, I hear it in conversation.  Last year, I heard a NASCAR driver refer to another driver as bipolar because the first driver was angry with the second driver.  The weather is NOT bipolar.  It does what it does because of the jet stream and other factors.

There are a lot of different ways people experience bipolar.  But, I’m only going to deal with depression and hypomania right now, because that’s what I’m experiencing.

Today I’m in a high hypomanic state, so I have a lot of energy.  However, that energy is unfocused, and as much as I try to bend it to my will, I always fail.  My brain is running so fast that I can’t even keep up.  I can say that there is a rapidly running list of all the things that I wish to accomplish, various song snippets and oddly enough single words punctuate the din.  Today, that word is Mog.  It’s from a book that I’m reading, or trying to anyway.  So, my list runs through my brain, song snippets punch their way through and every so often I hear “Mog”.   It’s a very odd sensation to have all of this going through my brain all at the same time.  It’s like a tornado.  I hear the roar of all the thoughts swirling around constantly,  never stopping.  Occasionally one of the song snippets, or words or things I want to do pop out of the noise, only to be immediately sucked back in.  I can’t grab onto anything for more the a millisecond and it’s gone again.

But that’s today.

And yesterday.

But I want to talk about the slur.  Ultradian cycling is where I believe that the slur “bipolar” comes from.   Ultradian cycling, or ultra-ultra rapid cycling is when the hypomanic state I described above switches back and forth with depression up to several times in one day.  I have experienced this state for 3 days in a row this week.  At one point, I was actually experiencing hypomania and depression at the same time.  So I had a lot of energy, but my mood was very low and I didn’t want to do anything.  But the hypomania tried to override the depression with its energy and need to move move move.  That is a hard way to spend the day.

Experiencing ultradian cycling, well, there’s no way that I could describe it that makes any sense.  The level of noise in my head doesn’t stop.  But, one minute I can barely get off the couch no matter how much I want to, and 15 minutes later I’m agitated, and energized, but unfocused and useless.  This type of existence is so difficult.  Imagine having your brain never be quiet.  Imagine having more energy then you have on a regular day, but being unable to focus it.  If someone has the misfortune to start to talk to you, they will find a never-ending stream of things that you feel you must talk about right now.  But, you don’t make a lot of sense, because you’re too unfocused and you bounce from subject to subject.  Tasks are left half done because the level of concentration needed to finish one thing before moving on to the next just isn’t there.  And then, mid-task, the energy just dissipates.  Your body becomes sore for no reason that you can figure.  But, it’s the depression.  The depression makes your body hurt, although it does nothing for the raging tornado of thoughts in your head.  But, now, you must sit.  You can’t talk to anyone without great effort, because with depression, and hypomania, come anxiety.  The sound of other voices grate on your nerves.  The realization that you are getting nothing done grates on your nerves.  Then the guilt starts to creep in.  You’re being useless, but you just can’t move.  Or if you can move, it takes every last bit of energy you have to do so.  You plaster a smile on your face, because you should.  You don’t want your family to worry.  You try to engage in conversation if you absolutely have to, but you don’t want to.  It takes so much energy to hold a conversation.  Never in your life you would have felt that a conversation would take so much energy.  But, it doesn’t matter, because you’re bouncing back to hypomania now and the energy starts to flow.

Living like this is hard.  Living like this is harder than I ever could have imagined.  I never in my wildest dreams thought that it could take so much energy to just exist.  To just have a nice conversation.  To go to a fair with my family.  To go grocery shopping.  To pick up my prescriptions. None of these things are hard for a normal person, but depression makes them almost impossible.

I’m prone to these ultradian cycles.   It happens a couple of times a year at least.

This is a short bit of what it’s like to live with bipolar disorder and especially ultradian cycling.  I ask only that before you allow the words “S(he)’s so bipolar, that you consider what it’s actually like to live with bipolar.  You are not hurting the person you are calling bipolar, but you are hurting the people like me who struggle every single day just to make it through.

Is there satisfying Bipolar success?

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Bipolar depression is here, again, still.  I hate it.  I hate feeling this way, and more than that, I hate feeling this way for no actual reason I can pinpoint.  Nothing is wrong, in fact everything is going rather well.  But, every afternoon this week, I have felt that dip.  Today, the dip became a ditch and it started at dawn.

I knew it the second I woke up.  I felt the low.  You know the low that you can’t pretend you don’t feel?  That one.  I started to get up and hubby asked me where I was going.  I managed to say ‘to make the coffee’ without being overly snippy.  I mean, it’s where I go every morning!  Why do you have to ask?  But, he’s not being rude or mean, I am, bipolar is.

Therapy was slow to start today as I wasn’t really in the mood for talking.  But, and I don’t remember what, something go me going on the way I measure success in my life now vs the way I measured it “then”.

For example, last week the rod in our closet fell down and all of our clothes ended up on the floor.  So, while hubby fixed it, I went through every single item of clothing I own and tried everything on and sorted it into piles to keep in a drawer, re-hang, donate, or put in a tote in the garage.  While I was at it I ran across several pair of pants that fit, that didn’t have drawstrings.  And the very first thought was ‘ I should make a separate pile of these pants in case I have to be hospitalized again’.  But, I didn’t do it.  And that is considered a success in my life now.

I used to close real estate deals all day long.  I used to be well-known in my area for being able to take the toughest deals and make them work.  I had excellent problem solving abilities.  I liked doing it.  I managed two companies.  At the same time.  And then I went home and cleaned and did the laundry and cooked dinner and lived my life.  These successes were important to me.  I didn’t even have aspirations to do more.  I loved doing what I did.  I loved solving problems and getting people to understand what they needed to understand.  I loved helping people buy their new homes in which they could make their own lives.

I was successful at a high stress, fast paced job that I adored.  Now, I’m supposed to pat myself on the back because I got one load of laundry done.

I know that there are people out there who get diagnosed, get their meds worked out and go back to living fulfilling lives doing what they love.  I will never be one of those people.  Treatment resistant with co-occuring disorders, has crippled me.

Now my victories are small.  They are things I never would have thought about twice in my old life.  Made dinner – yeah so did every other person in the country – whoopee.  Did laundry – yeah so did every other person in the country – yay.  Didn’t organize my pants into which ones were suitable for the hospital and which ones weren’t.

The pants thing really bothers me.  I know that I should be happy that I haven’t tried to organize my life so a hospital stay is easier to prepare for.  But, I’m not.  I see where it’s a success, but I think it’s a pathetic excuse for a success.

And then the passive suicidal ideation train drove through.  I’ve taken to just calling it the “passive train”, because it tends to just drive by.  It might be a long freight train or a shorter passenger train, but it keeps moving.  Which is good, because if it stops, the only passenger is active ideation, and I don’t want that.

But, comparing these successes in my old life with the things I’m supposed to call success now, brought the passive train by.  I feel like the expectations I need to meet are those of a child and I didn’t live all this life to end up feeling like the most I can accomplish is the same as a tween.  And if that’s the best I can hope for, then what the heck is the point?

Thankfully, I’m not low enough yet that the point completely escapes me. The point, ultimately, is my family.  They don’t look at my successes the way that I do.  Hubby wants to know that I’m ok.  And, if I’m ok, then he’s ok.  He doesn’t look at me and think about what I used to do and accomplish and wish that was the way things are now.  He looks at me and wants me healthy, bipolar or not.

 

Chutes and Ladders Bipolar

Remember that game from your childhood?  The object was to get to the top of the board first.  But, there were pitfalls in the form of chutes that could send you down one level or six.  But, there were also ladders and if you were lucky enough to land there you could skip a few levels or six.  Considering the game board had 10 levels, those times you were lucky enough to hit a six level ladder put you sitting pretty.  But, that six level chute could put you far far behind.

I’m not the first person to compare bipolar to chutes and ladders, and I won’t be the last.  I may not even be the best.  And that’s fine.  But, I’m on a chute now, and I don’t know how many levels I’m going to go down.

A lot of the times the mood shifts that bipolar causes are like the roll of the dice.  There aren’t any triggers, or stressors, or anything that your constantly running brain can find for the change in mood.  You simply got a roll of the dice that sent you up a ladder into hypomania or mania, or you got a roll of the dice that sent you down a chute into depression.

Because a lot of the time the mood shifts aren’t generated by anything external at all.  I’m currently on a chute on my way to depression, but there is no external reason for it that I can find at all.  No triggers, no stressors, no one has said or done anything to set me off.  Even my OCD is holding steady.  Yet, down I go.

I’ve experienced the ladders as well.  Last week even.  No reason.  My sleep was the same, my meds were the same.  But up up up I went.  And for a couple of hours it was great.  I love hypomania at the beginning.  I got a ton of stuff done, really fast.  But, as is usually the case with me and hypo, aggravation set in rather quickly.  And then, even the sound of another human being’s voice sets me on edge (if I’m able to control it) or sends me over an edge of extreme anxiety and irritation (if I’m not able to control it).

Chutes and Ladders is a very simplistic way to describe a very complicated condition, I know.  But it struck me because sometimes it is as simple as “no reason” (roll of the dice) for the mood changes.

It’s hard for our loved ones to understand that this morning we were happy and this afternoon we’re not.  For them, there is a reason that their moods change.  Even if it is as simple as not getting enough sleep, there is a reason.  I hate answering the question “why are you so down now when you were good this morning?” when the reason is that bipolar disorder decided that I am going to be down now.  No, no reason.

Just bipolar.

Well….

Boy have I been missing in action recently.

Hubby and I went on a vacation.  The week prior to the vacation was an exercise in organization and planning and completing tasks.  It was an extremely stressful week for me.  In a sense it was back to a life of deadlines.  I had my tasks written out for each day and each day’s tasks needed to be completed before the next days tasks could begin.  I was popping every Valium I am allowed to have in a day just trying to keep it together.

But, the payoff was amazing.  We went on a cruise.  We got an amazing deal and we decided to go for it.

Now, I know that I was still bipolar while I was on that ship.  I know I still had Generalized Anxiety Disorder.  But, I didn’t feel it.  I felt normal.

Let that sink in.

I felt normal.

It makes sense.  None of the normal day to day stressors and triggers.  Nothing to have to accomplish.  Wanna sit at the bar and drink and smoke all day?  Ok.  Wanna go in the pool? Ok.  Wanna go to the Casino?  Ok.  Hey, let’s eat.  Ok.  When the day to day grind goes away and you’re not responsible for anything except your most basic needs like going to the bathroom and showering, it’s easy to lose all that stress and depression and racing thoughts and all those horrible things that we live with 24/7.

I even allowed a monkey to sit on my head.

 

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I told people who asked about my tattoo exactly what it meant to me and that I’m bipolar.  And I didn’t give a flying fig if they didn’t like it.

I was free.  For one blessed week, I was free of it all.  I can’t begin to tell you how relieved I was.

Sadly, my normal post-vacation routine kicked in right away and I developed a raging sinus infection and bronchitis.  So, that kept me down for a couple weeks, too.

But I’m feeling better now, at least physically.  Bipolar and GAD have settled back into my daily life.  I’ve been having a hard time dealing, because I’ve been trying to hold onto the feelings that I had (or didn’t have) during my vacation.   But, at therapy this morning, Karen encouraged me to come back here and write.   Because there is much to be learned from the times when we feel good, as well as from the times we feel bad.

I hope that all of you have been ok.  There’s no way I can catch up on the posts I’ve missed and for that I’m sorry, but it’s just not something I can do right now.

I have a lot of things I want to talk about coming up but a key one is disability.  I have a question for all of you and answers can be emailed to me at normalisoutthere@gmail.com if you don’t want to leave them in the comments.  The disability system needs an overhaul.  Mentally ill patients wait years for disability to come through and some end up homeless or incarcerated as a result.  I have been fortunate to have a husband with a job and health insurance.  Yes, finances are tight, but we are doing ok.  I’m the lucky one, and I know it.  Anyone who is willing to share their stories about how they made it through that time between applying for disability and actually getting it, I’m really anxious to hear them.  You can leave them in the comments if you like, but feel free to email them to me if you don’t want them public.  And they never will be public.  Ever.  I promise.

Peace and love y’all.

 

 

 

My Speech for the Rally against the ACHA

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My name is Leslie Bracken and I have bipolar disorder.  I have a few other things, but that’s the one that usually freaks people out.

I’m not the first one to suffer from Mental Illness, and sadly I won’t be the last.  In this country 1 in 5 people are diagnosed with a form of mental illness every year.  1 in 25 are diagnosed with something serious, like bipolar disorder.  1 in 5 children aged 13-18 will experience severe mental illness in their lifetimes.  50% of all substance abuse patients are also Mentally Ill.  This is because medications often don’t work well or side effects are untenable.  The options left are to self-medicate using drugs or alcohol.

It’s expensive to treat the mentally ill.  Besides the 50% of us who have co-occurring Substance Abuse Problems, the doctors are very expensive and the medications can be as well.  We also have an increased risk of chronic medical conditions.  We die, on average, 25 years earlier than normal often due to untreated, but treatable, medical conditions.

President Obama felt that these problems were significant enough that one of the mandates of the ACA was that ALL healthcare policies, including those not purchased through the marketplace, had to have provisions for Mental Health and Substance Abuse Programs.

So, the Affordable Care Act, covers us.  It covers us through employer health care plans, through Medicaid and its expansion, and through Medicare.  It’s the only thing we don’t worry about.  These mandates of coverage through the ACA cover 62 million Americans for Mental Health and Substance Abuse no matter where the insurance was obtained. When you consider that the Affordable Care Act covers around 20 million people directly this is an astonishingly great accomplishment for the other 42 million.

But Representative Mark Sanford and the Freedom Caucus look to undo the Essential Coverages that President Obama gave us.  Those Essential Services are Maternity Coverage, Emergency Services, Substance Abuse Rehabilitation, Laboratory Services, Preventive Care, Pediatric Services, Ambulatory Services, Prescription Coverage, Hospitalization and Mental Health Services.

I routinely use Prescription Services, in fact I take 8 separate medications to stabilize my conditions.  I use Laboratory Services, because of the specific medications I take.  I use Mental Health Services, because I need therapy and a psychiatrist.  And on occasion, Hospitalization Services when my disease gets away from me.

As of 2020, Mentally Ill Medicaid recipients may longer have access to Mental Health Services or Substance Abuse Programs.  These are the poorest of the poor and I personally know some of them struggling with the same issues I do.   1 in 5 Medicaid recipients have a Mental Health Condition.  That means 20% of Medicaid recipients could easily lose their insurance to help with one of their most awful afflictions.

I’m very blessed.  My husband has a decent job with a big company and we have great healthcare.  However, if the Mandate for Essential Services is removed from the AHCA, it’s a logical next step for companies to start offering stripped down versions of health insurance.  Will I lose my lifesaving coverage or will I have to pay an exhorbitant “surcharge” to get those services back?  I don’t know the answer, but the possibilities have me worried.

What about the people, though, who rely on Medicaid to get their treatment?  What happens to them?

I desperately hope that I have made my point clear to all of you today.  Living with Mental Illness sometimes means that my anxiety is too high or that I forget things that are important.  The services I receive through the ACA Mandates are crucial to my survival

I call on Representative Mark Sanford to not forget the people who have already been left behind in so many other ways.  The vote is tonight and his office knows we’re here!

 

Researching the ACA and ACHA

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So, I’ve been doing a LOT of researching over the past 24 hours into what the Affordable Care Act (Obamacare) did for those of us with mental illness and what the American Health Care Act (Trumpcare?) is proposing to do.

The really really short answer?  The AHCA is planning to do nothing.  Except rollback the protections we had under the ACA.

First, some statistics.

  • 1 in 5 Americans will experience mental illness during any given year.
  • 1 in 25 Americans will experience a serious Mental Illness during any given year.
    • Understanding of course, that all Mental Illnesses have the potential to become serious.
  • 1 in 5 youths (ages 13-18) will experience severe mental illness in their lifetime.
  • 50.5% of adults who experience a Substance Abuse Problem also have a Mental Illness

Now, the Affordable Care Act currently has mandates in place that ALL health insurance policies, no matter if they are purchased or provided through Medicaid, must include treatment options for Mental Illness and Substance Abuse Programs.  Currently, that means that about 62 million people are covered for these conditions no matter what insurance plan they have. ( U.S. Department of Health and Human Services)

That’s a lot of people.  When you figure that the ACA covers about 20 million people directly, it is also helping another 40+ million just in Mental Health and Substance Abuse Programs alone.

I also know that the Affordable Care Act is not perfect, so please don’t yell at me in the comments.  Thank you.

Now, the American Health Care Act:

The AHCA strips away requirements from Medicaid to cover Mental Health and Substance Abuse Programs.  There will be grants, given to states who apply, for money to fund these programs.  But those grants will be gone by 2026.  And your state MUST apply for those funds.  In my state, which did not do a Medicaid Expansion under the ACA, I have serious doubts that we will be applying for that money.  If you live in a state that does have Medicaid Expansion, hopefully your chances are higher.  This is absolutely a state by state thing.  You must be prepared to contact your governor about applying for this grant if the AHCA passes.

What’s Medicaid Expansion you ask?  Well, Medicaid used to just cover people who lived under, or just at, the poverty line.  For this year those figures (up to a household of 4 people) are:

  • $12,060 for individuals
  • $16,240 for a family of 2
  • $20,420 for a family of 3
  • $24,600 for a family of 4

(courtesy of Healthcare.gov)

Medicaid Expansion allowed people who made up to 138% of the poverty line to still enroll in Medicaid.  So, for one person, that would now be $16,642.80.

However, as I said, not all states took the Medicaid Expansion option.  Whether those states will or can apply for the money to keep Mental Health and Substance Abuse Programs will remain to be seen if the AHCA becomes law.

But, regardless, the AHCA eventually looks to phase out the Medicaid Expansion altogether.  Which means that a person making $15,000.00 will have to pay for their health insurance out-of-pocket.  Yes, there are tax credits.  But, they are not enough.  Sick people and old people are going to have a very tough time.  Now, another interesting fact is that non-elderly adults working with disabilities are significantly less likely to have a job that provides health insurance.  So it’s a decent bet that the person making $15,000/year has a job without health benefits.

Representative Joe Kennedy (D-Mass) and Representative Peter Welch (D-VT) introduced an Amendment in committee to include mandates for Mental Health and Substance Abuse Programs, but the Amendment failed and it failed straight down party lines.

It FAILED.  I can’t say this strongly enough.  Failing to protect 60+ million people from ANY disease is despicable, deplorable and immoral.

The Congressional Budget Office (CBO) released their assessment of the AHCA last week.  It’s going to reduce the deficit by a lot.  But it’s going to do that at the expense of citizens being able to obtain healthcare.  And that means us, the Mental Health Community, as well.

There are serious questions here.  If you are just over the poverty line, will you be able to afford to buy health insurance WITH Mental Health and/or Substance Abuse coverage?  If you are below the poverty line, will you be able to continue to get Mental Health or Substance Abuse coverage?  If you happen to be the spouse of a mentally ill wife will you have to pay extra for coverage for her mental health treatment?  And finally, with the AHCA doing away with employer mandates to provide insurance, will ANYONE get health insurance through their jobs anymore?

Tomorrow I will be speaking at a rally (I suspect with a healthy dose of Valium on board!!) about these issues.

The vote in the House of Representatives is Thursday.  Do yourselves a favor and call your Representative today and express your thoughts on how he/she should vote.

Don’t have your Representative’s contact information.  Not a problem.  Click the link below and enter your zip code.  If your district is very gerrymandered (like mine) you’ll need the 4 digit extension to your zip code to narrow it down.

Find my Representative