This week is do or die for the new GOP Healthcare plan. As of this writing, Paul Ryan and Donald Trump are currently meeting with members of the Republican Party in order to drum up support for the proposed bill that will replace the Affordable Care Act.
Already the GOP’s healthcare plan, called the American Health Care Act, has received staunch criticism from both sides of the aisle. Democrats are opposed to just about anything Trump, and some Republicans are against the bill for its large cuts to Medicaid, while others are against it because they feel there aren’t enough cuts to Medicaid.
Politics aside, this bill has the potential to leave 1.3 million Americans, who have used the expansion of Medicaid coverage that was offered under Affordable Care Act to get mental health and substance abuse services, without coverage for these vitally necessary services.
What the bill proposes is that in 2020, the Affordable Care Act requirement that Medicaid offer basic mental health and substance abuse service, will no longer be a federal requirement, but rather the states will be able to decide for themselves whether they want to include these services in Medicaid plans.
Taken at face value, this isn’t the worst thing that could happen, considering that many states who expanded Medicaid coverage would more than likely still include these services as to not anger constituents, but when taking into account that under the American Health Care Act, Medicaid funding will be restructured into block grants, many states may be unable to afford these services.
For the past 50 years, the Federal Government gave states funding for Medicaid based on an as needed basis. Meaning that if more people in the state became eligible for Medicaid services, then the state would receive more funding for the program, but under the American Health Care Act, this would change to block grants, which would enforce a cap as to how much any state could receive in funding. So if a state experienced a dramatic increase in Medicaid eligible residents, there would be no more funding for that state, and they would have to make due with what they had.
In light of this information, we may see that many states can simply not afford to offer mental health and substance abuse services to Medicaid participants. Beyond the fact that denying these services to anyone is abhorrent, many of the individuals who will be affected by these changes, if they do so change in this way, will be those who live below the poverty line, a population that is often hit hardest by substance abuse and mental illness.
The scope of this change is staggering considering that 74 million Americans, or roughly 1 in 5 Americans are provided health insurance through Medicaid. Under the proposed changes, these individuals would only have access to whatever federal funding the government is willing to give, and unfortunately, as we have seen in the past, when money runs lows, services considered to be ancillary are usually cut.
Although Donald Trump ran on a platform of eradicating the opioid problem we have in this country, his new healthcare bill will more than likely have the exact opposite effect. This is not to say that treatment for drug addiction equates to a cure by any means, but without even the option of treatment, many poor drug addicted Americans will be left floundering without the ability to receive help.
As it is stands now, many state run facilities for substance abuse who do not require insurance or money, are already filled to capacity, and if less and less individuals are able to receive insured treatment for their substance abuse issues, this problem will only get worse.
Besides changes to Medicaid, the American Health Care Act may also adversely affect those individuals who do not qualify for Medicaid, but received insurance through the Government Marketplace. Experts are saying that under the proposed bill, 26 millions Americans could possibly lose health coverage over the next few years, and that the changes would bring about increased premiums, a reduction in tax credits for the poor and middle-class, and an increase in tax credits for the rich.
All of these things spell disaster in the end, as more and more people will be unable to afford health care, which for people with mental health issues and substance abuse problems, could result in an increase in deaths. Something that is often overlooked in this debate is the fact that people with mental health issues don’t just need access to treatment, but also need access to medications that can help to keep their symptoms at bay. If they cannot afford health insurance and do not qualify for Medicaid, they may be left without their medication, which is not something that anyone wants to see happen.
No one can truly say how any of this play out in the end. It isn’t even clear yet that the proposed bill will pass through Congress, but what can be said is that this is, in a sense, an attack on those disenfranchised and sick Americans who for far too long, have been relegated to the margins of society. The mere proposal is not a victory for proponents of smaller government, but rather it is a loss for all of us. Hopefully, some day soon, we will come to understand that every individual, regardless of race, creed, or socioeconomic status, should have access to life saving treatments and care.