We are the ones. And now is the time.
“If not us, who. If not now, when?”
- Hillel the Elder
I have had many sleepless nights in 2017. Since our nation’s political leaders entered office in January, pledging to drastically cut and reshape our nation’s health care system, I have laid awake worrying about the fate of millions who rely on Medicaid for mental health and addiction care. Many of you have told me you do the same.
But these sleepless nights quickly turned to action when we asked ourselves “If not us, who? If not now, when?” Together, we stepped up to bat for Medicaid and the people it serves, because simply put, “We are the ones. And now is the time.”
After a long fight, we rest easy…for now. With last week’s failure of the Senate health bill, massive Medicaid cuts appear to be off the table in the short term – one of the most remarkable achievements of our collective advocacy. Because you stood up and fought for what is right, Congress is recognizing, in the words of Politico reporter Rachana Pradhan, that Medicaid may be the next “third rail” in American politics.
Medicare and Social Security have long been considered untouchable, in part because older Americans vote. For too long, people receiving Medicaid – including those who are elderly, poor or disabled – were considered politically expendable. But no more. You stood alongside the National Council and made clear that a program that provides lifesaving treatment for Americans with opioid addiction, insures 40 percent of all births and pays for 60 percent of all long-term care and nursing home days is a critical part of the health care safety-net.
The Senate called its health care bill the “Better Care Reconciliation Act,” but there is nothing “better” about it. It would have stripped health insurance from millions of vulnerable Americans and radically restructured the Medicaid program while enacting major tax cuts. It’s not a health care bill – it’s a tax bill that will impose suffering on millions.
When the Senate first began considering this legislation, New York Times columnist David Leonhardt bemoaned what he called “the halfhearted opposition to the GOP’s health care misery.” He wrote that previous attempts to reform the American health care system met with a vigorous response from industry groups and wondered where they were now.
But we were always in the fight, and you were right there with us.
You came together to Unite4BH. More than 4,000 members sent more than 12,500 messages and made more than 2,000 phone calls reaching some 500 legislators. Your tweets – at least one an hour – reached more than 19 million people. You put your money where your mouth is, flying to DC to tell your Senators and Representatives that Medicaid saves lives.
The latest proposals to end the Medicaid expansion and move individuals to private coverage don’t add up. The Congressional Budget Office projects that the average deductible for private plans purchased on the newly revised exchanges would be $13,000 – that’s $1,000 more than the annual income of a person living at 100 percent of the federal poverty level. These plans could exclude coverage for mental illnesses and addictions, and tax credits don’t help pay for deductibles (estimated at $15,500 per year). Who thought this was a good idea?
Not the National Council Board, which said, “Do what you have to do, protect Medicaid.” The National Council launched radio ads, mobilized advocates, pounded the pavement on Capitol Hill, issued state-by-state fact sheets about the role of Medicaid in caring for people with mental illness or addiction, spoke to dozens of news outlets and provided resources for Americans to host local rallies protesting the impact of the bill in Maine, Ohio, West Virginia, Alaska and many more states – urging Senators to protect Medicaid coverage for Americans receiving treatment for substance use disorders.
We knew our voices were heard when, to appease Senators from these states and others that have been especially hard hit by the opioid epidemic, $45 billion in grant funding was added to the Senate bill to replace the $772 billion lost Medicaid dollars. This was insulting, at best, and a death sentence, at worst. We intensified the fight, arguing that we don’t treat heart disease or diabetes with grants, and addiction should be no different.
Our dedicated public policy staff led by Chuck Ingoglia and Rebecca Farley David have been on the Hill day and night with the message that the Better Care Reconciliation Act would take us back to the days when individuals with mental health problems could be denied coverage and insurers could stop paying for addiction treatment because someone reached their lifetime cap.
More than 450 of us signed a letter imploring Senate Majority Leader Mitch McConnell and Minority Leader Charles Schumer to maintain vital funding for people with substance use disorders and mental illnesses and the providers who serve them.
And with the help of the National Council’s communications team, you told your stories in the media. Stories like the Pine Street Inn, which without Medicaid would have to eliminate stabilization and day treatment, targeted case management services for individuals with HIV/AIDS and supportive case management services. Or Forks Community Hospital in Washington state, which might close its doors, leaving more than 1,300 people served under the Medicaid expansion without care.
As you stood up, our Senate champions did, too. Massachusetts Democrat Elizabeth Warren told her colleagues, “Take a look at what the experts are saying…the National Council for Behavioral Health says, ‘Instead of repeal and replace,’ it is ‘wreck and wreak havoc.’” Illinois Senator Dick Durbin tweeted the National Council’s statement saying, “Medicaid #1 tool to fight opioid epidemic. @SenateGOP idea to gut Medicaid & offer weak pledge of grant $ is meeting this crisis w/ a shrug.”
And, finally, industry trade groups were silent no more. America’s Health Insurance Plans, together with the Blue Cross Blue Shield Association, called the Better Care Reconciliation Act “unworkable in any form.” American Medical Association CEO James Madara wrote, “Medicine has long operated under the precept of primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”
At the end of the day, the Senate health bill failed in a dramatic late-night vote, allowing us to breathe a sigh of relief that Medicaid is safe…for now. We have won several battles, but the war is not over. The pressure on Congress to act on health care is intense, and we still fear a revival of some of the worst proposals. We must not rest. If Medicaid is radically restructured, we will be waging these battles for years to come.
I can’t thank you enough for the work you have done thus far – the National Council made a difference, you made a difference. As you catch up on those sleepless nights – I encourage you to keep your spirits high for the long road ahead. In the words of the late Senator Ted Kennedy, “The work begins anew. The hope rises again. And the dream lives on.”