Senate Rushing to Vote on Huge Medicaid Cuts Next Week
On Thursday, the Senate released a draft of its health care bill to gut Medicaid and repeal the Affordable Care Act. Despite earlier claims that the Senate would create a more “generous” bill, their proposal goes even further to destroy Medicaid and Medicaid expansion. The bill is likely to be amended and scheduled for a vote next week.
The Senate bill, entitled the Better Care Reconciliation Act of 2017, would rip away health care coverage and limit benefits for millions of Americans living with mental illness and addiction. To learn more about how this bill harms individuals with mental illness and addiction, read the National Council’s Statement here and see the summary below.
Overall, the Senate’s proposal maintains the major provisions in the House-passed American Health Care Act (AHCA). However, there are a few notable changes related to behavioral health:
- Decreases Per Capita Cap Growth Rate: Like the AHCA, the Senate bill would fundamentally change Medicaid financing from an open-ended federal and state matching formula into per capita allotments or block grants (as chosen by each state). However, the Senate bill reduces Medicaid funding further by tying the per capita cap growth rate to inflation, a slower annual growth rate than what was proposed in the House bill.
- Ends Medicaid Expansion Over Three Years: The federal government would begin phasing out the enhanced federal matching rate for Medicaid expansion starting in 2021. This move would make Medicaid expansion much more expensive for the states, likely leading them to end their expansion programs.
- Creates Small, Inadequate Opioid Fund: The nominally titled “Support for State Response to Opioid Crisis” fund provides one-time monies totaling $2 billion for 2018 for unspecified “substance use disorder treatment and recovery support services for individuals with mental or substance use disorders.” This fund does even not come close to the funding level needed to address opioid addiction, particularly in light of the huge coverage losses that would result from this bill.
- Loosens IMD Rule: Allows for Medicaid payment for services provided in psychiatric hospitals for up to 30 days, not to exceed 90 days in one year. As above, this provision does nothing to make up for the fact millions of people with behavioral health disorders will be left without health insurance should this bill become law.
- State ACA Waivers: The bill incentivizes states to apply for 1332 waivers that would allow them to waive key protections of the Affordable Care Act. The provisions include the requirement for insurance plans to cover essential health benefits (including mental health and addiction services) and protection for individuals with pre-existing conditions.