It was a typical spring day when Olympic Gold Medalists Allison Schmitt and Michael Phelps received special recognition awards from the Substance Abuse and Mental Health Services Administration (SAMHSA). During the ceremony held at George Washington University both Schmitt and Phelps spoke openly about their personal battles with depression. The awards were presented by Health and Human Services Secretary Tom Price, M.D. “Mental illness and drug addiction, along with childhood obesity, are some of the most urgent challenges facing America today,” said Secretary Price. “As Secretary of HHS, promoting the behavioral health of all Americans and reducing the impact of substance abuse and mental illness on our communities are among my top priorities.
This was SAMHSA’s annual event to recognize National Children’s Mental Health Awareness Day 2017 “Partnering for Help and Hope” which focuses on the importance of addressing physical, mental, emotional, and behavioral health needs when providing services and supports for children, youth, and young adults. There has been a notable increase in overall rates of major depressive episodes among all adolescents.
There was another celebration going on at the same time in Washington D.C. no more than a mile away from the “Partnering for Help and Hope” event. In the White House Rose Garden, President Trump and a group of House Representatives bestowed each other with adulations and pats on the back for the narrow passage of a piece of legislation that – if passed by the Senate –will effectively strips millions of Americans of addiction and mental healthcare coverage. “We’ve taken a historic first step to repeal and replace Obamacare and finally give the American people the kind of health care they deserve,” Vice President Mike Pence stated, prompting a thunderous applause.
The cruel irony was completely lost on the lawmakers as they joyfully toasted each other and sipped on their chilled bubbly refreshments in the comfortable surroundings of the Rose Garden. However, the celebration seems a bit premature as they’re normally reserved for a bill signed into law.
There are many who have suggested that the passage of the American Health Care Act (AHCA) in the House is an example of Trump making good on his campaign promise to repeal and replace the The Patient Protection and Affordable Care Act (ACA). But attached to that promise was a better healthcare program than the existing ACA with lower premiums, lower co-pays and better coverage for all Americans. Those promises remain unkept leaving many to wonder how the new healthcare program will affect them. The answer to that question varies from person to person, unless of course you’re an addict or have mental health issues in which case the answer is devastating.
The core of The Patient Protection and Affordable Care Act (ACA) is the requirement of participating insurance companies to cover the “Essential Health Benefits” as outlined in the bill. Included in the benefits is mental health and addiction treatment. This one element of the ACA dragged mental health and addiction out of the stone age and placed the diseases squarely in the twenty-first century. It is the first time in American history that mental health and addiction were rightly identified as diseases that warrant insurance coverage like any other disease. It’s my opinion that the ACA did more to remove the stigma attached to poor mental health and addiction than any law before it.
The ACA went further by making sure middle and lower income Americans have access to treatment. It gave states the option to expand their Medicaid programs to cover all people by increasing eligibility levels for individuals and families with a household income below a certain level. Thirty-one states and the District of Columbia adopted the plan and it’s working. Specific data is hard to come by, but reputable sources estimate that as many as ten million Americans now have access to healthcare – some for the first time – from this one provision in the ACA. Moreover, the ACA provides Premium Tax Credits (PTC) on Marketplace insurance plans for individuals and families who don’t qualify for Medicaid but still cannot afford health insurance. In all, the ACA has provided more than twenty-million Americans with access to healthcare that previously had none.
But more to the point, the Affordable Care Act provided the first opportunity for millions of low and middle income Americans to get mental health and addiction treatment. In addition, the federal government has committed billions of dollars to help addicts find recovery and turn the tide on America’s opioid epidemic. And the program is working.
As flawed as the Affordable Care Act may be, it did set the tone and move the direction of mental health and addiction treatment forward. Its possible replacement, The American Health Care Act, is about to change all of that and more. If passed in its current form by senate and signed into law by the President, mental health and addiction treatment will become severely compromised. This new measure will effectively send addiction and mental health treatment back to the stone-age with less coverage and higher premiums and co-pays – exactly one-hundred and eighty degrees opposite of the politician’s promises.
Below are the five key areas where the American Health Care Act will eviscerate treatment for people with addictions and mental health issues.
Medicaid is a federal program established over fifty-years ago and adopted by all fifty states and the District of Columbia. It provides matching funds to participating states for the expressed purpose of providing medical assistance to residents who meet certain eligibility requirements such as low income adults, their children, people with disabilities, pregnancy or being a woman with children. Each state administers its own Medicaid program.
Under the bill passed in the House, federal spending on Medicaid would be slash by $880 billion over ten-years. Medicaid expansion, the program responsible for insurance coverage for up to ten-million Americans, will be phased out by 2020.
In addition, the funding of Medicaid will be changed from its current federal/state partnership each paying their share person by person, to a block grant from the federal government. This is an optimal option for the feds but leaves states with less money for treatment. Many healthcare experts have stated the block grant will force Medicaid to revert back to being a program for just a fraction of the poor.
Under the Affordable Trade Act, subsidies are given to the insurance companies or tax credits to low or middle income beneficiaries to make insurance affordable. The proposed healthcare bill will eliminate these subsidies leaving these Americans without healthcare coverage.
Essential Health Benefits
The American Health Care Act that was approved by the House in May 2017 eliminates the federal requirement stipulating that insurance companies provide coverage for the health issues identified within the Essential Health Benefits of the ACA – including mental health and addiction. That authority to require what insurance companies cover is being passed down to state level.
Altruistically, I’m sure most states would want coverage for their citizens with addiction and mental health issues. But, with limited financial resources and shrinking dollars coming from the federal government, something has to go. State officials are going to be forced to make very difficult decisions if the American Health Care Act becomes law.
Under the current Affordable Care Act, insurance companies are required to insure people with pre-existing conditions. The law also prohibits insurance companies from charging people with preexisting conditions higher premiums. The new bill passed in the House would eliminate these protections and allow states to waive them as well.
According to the Kaiser Family Foundation, a nonprofit focusing on health care research, these are just a few of the conditions universally used to deny people coverage:
• Alcohol or drug abuse with recent treatment
• Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia)
There are a lot more – in fact, so many that the list is too long to print here but you can find it online.
High Risk Pools
If you are an addict or have mental health issues, chances are you’ll end up in a state run, federally funded high-risk pool. In theory, these pools are made available to people with medical histories, such as addiction and mental health issues, to get coverage at standard prices. But what politicians are reluctant to tell you is that the pools are grossly underfunded – so much so that Ohio’s Governor, John Kasich, laughed at how little the federal government budgeted for the program stating that” It’s ridiculous; and the fact is, states are not going to opt for that.”
If you think you’re safe because you get your health insurance through your employer, you’re not! The Brookings Institute found a last-minute amendment that they claim by “allowing states to define “essential health benefits” could weaken Affordable Care Act’s protections against catastrophic costs for people with employer coverage nationwide.” With the exception of politicians whose healthcare is unaffected by this bill, everyone, regardless of how or where you get your health coverage, will be exposed to some negative affect from this legislation if it becomes law.
It just seems counter intuitive to me to take away the very resources that have been effective in treating addiction and saving lives in the middle of the worst opioid epidemic this country has ever seen. Does any of this reality live up to the rhetoric?
One politician has gone so far as to say, “Nobody dies because they don’t have access to health care.” This contradicts a 2009 Harvard study (most recent data on the subject available) that revealed some 45,000 Americans die annually due to their lack of health insurance.
After exhaustive research on the proposed healthcare plan, I find calling this bill the “American Healthcare Act” disingenuous – there is nothing American about it. If politicians were to be intellectually honest with us they’d call this bill the “You’re Going to Pay More and Get Less Healthcare – Draconian Act.” None of the political rhetoric lives up to the reality of what this bill does. The reality of the American Healthcare Act is your premiums and co-pays are going to go up for insurance coverage that goes down while tens of millions of Americans are left without insurance and tens of thousands die avoidable deaths every year from a new disease about to spread across this great country of ours called “inaccessible healthcare.” That is the unfiltered, raw unvarnished reality of the American Healthcare Act and none of us, unless you’re a politician, come out of this unscathed.
What I find truly astonishing is the politicians’ statements regarding this bill. I’m hearing them talk about slashing budgets, tax credits, tax rollbacks, high-risk pools and block grants. But nowhere do I hear them say how many more Americans will be covered, how outcomes will improve, new protections for people and how many lives will be saved by the American Healthcare Act. Isn’t that the whole purpose of healthcare – to keep us and our children healthy and alive?! You’d think that after the trillions of dollars we give in taxes every year, the very least our senators and congress men and women could do is provide us with a robust healthcare system at a reasonable price.
Ask yourself “does this bill help me or hurt me?” “Am I willing to entrust my most valuable personal asset, my health, to a politician intent on cutting healthcare budgets?” “Is this the kind of health care I deserve?” “Is my congress man or woman or senator working for me or against me?” “Do they expect me to accept less than what I currently have?”
Everyone has something to lose if the American Healthcare Act is passed in the senate. No one gets to ride the pine and sit this one out. Now, more than ever, it is imperative you call your senator and tell them to vote “no” on the American Healthcare Act. Social media is good but the simple fact of the matter is that phone calls carry the most clout. If you’re not sure who your senator is or what number to call, you can find a list of all senators and their numbers on my site www.preventaddictionrelapse.com.