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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.

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