House Passes AHCA, Puts Mental Health and Addiction Care in Jeopardy
Yesterday, the House narrowly passed the American Health Care Act (AHCA) repealing key provisions of the Affordable Care Act (ACA) and massively cutting the Medicaid program by $882 billion. The bill passed following the addition of an amendment that rolls back essential health benefits and protections for those with pre-existing conditions. The revised AHCA poses an even greater threat to individuals with mental health and addiction disorders and the providers that serve them. The bill now moves to Senate for consideration where a lengthy debate is expected.
The AHCA will have devastating effects on patients’ ability to affordable and comprehensive care. Patients with mental health and addiction disorders will be especially hurt as they disproportionately rely on traditional Medicaid and Medicaid expansion health plans for health care coverage. A summary of the AHCA’s most damaging provisions is provided below:
- Cuts Medicaid Benefits and Shifts Costs to States. The AHCA would fundamentally change Medicaid financing from an open-ended federal and state matching formula into per capita allotments or block grants. According to the Congressional Budget Office’s latest estimate, this change would result in $882 billion being stripped from the Medicaid program over 10 years. With less federal funding, states would be forced to contribute more of their own dollars, or cut enrollee benefits and/or provider reimbursement.
- Ends Medicaid Expansion. The AHCA also would end enhanced federal funding for the Affordable Care Act’s (ACA) Medicaid expansion. Without these funds, many states would likely choose to end their Medicaid expansion programs, depriving millions of low-income childless adults of health care coverage.
- Allows Americans With Pre-existing Conditions to be Charged More —States could opt out the ACA prohibition against insurers charging more some sick patients more for coverage, so long the state sets up a high-risk pool for people with pre-existing conditions. However, the latest amendment would only provide an additional $8 billion over five years to help people with pre-existing condition in such states, and health care experts say this amount is completely inadequate.
- Greatly Weakens Mental Health and Addiction Parity – Under the AHCA, states could exempt themselves from the ACA provision that require insurers to offer a minimum set of essential benefits (EHB). Essential health benefits specifically require health plans to cover mental health and addiction treatment. By removing the EHB requirement, many health plans may decide not to cover mental health and addition services. Further, the bill weakens parity by allowing large employers to choose minimum benefit requirements from any state—including those who have waived all consumer protections permitted under AHCA—resulting in decreased coverage not just for those on Medicaid or in the individual market, but those in employer-sponsored plans as well.
- Reduces Subsidies on the Individual Market – The AHCA would repeal subsidies that help individuals purchase insurance on the individual market and replaces them with much less generous tax credits. The repeal of the ACA’s subsidies would make coverage much more expensive for individuals with mental illness and/or addictions that do not have access to employer-based coverage.
- Allows Older Americans to be Charged More — The AHCA allows insurers charge older customer up to five times as much as younger enrollees.
- Could Cut School Services for Disabled Children — Many national education groups say the bill’s cuts to Medicaid jeopardize their ability provide services to children with disabilities and to offer services such as hearing and eye tests.
Immediately following House’s passage of the AHCA, the National Council released the following statement, “AHCA is not the National Council’s vision for health care in America. It takes us back to the days when individuals with mental illness, like depression or anxiety, could be denied coverage. To the days when insurers could stop paying for an individual’s addiction treatment because they reached their lifetime cap. We stand united across party lines with those who see every day the devastating impact of untreated mental illnesses and addictions on our nation.” Read the full statement here.