The Mental Health Impact of the AHCA (Trumpcare)

With the passage of the American Health Care Act in the House of Representatives, we may be approaching a mental health care crisis unlike anything seen before. Included in the bill is a provision to allow states to strike key provisions protecting Essential Health Benefits.

Whereas the percentage of uninsured once hovered around 16% of the nonelderly population, the ACA brought that figure down to 10.9% in 2015 — a record low. The non-partisan Congressional Budget Office estimates that 24 million Americans will lose coverage by 2026 under the first replacement plan, 14 million in just the next year. Without giving the Budget Office time to score the new bill, the House passed the measure by a slim majority.

The bill will dramatically affect mental health parity — the historical divide between coverage requirements for mental and physical health — by allowing states to define Essential Health Benefits. Prior to the ACA, the lack of parity meant insurers could limit or deny coverage for mental health services, letting insurers limit the number of therapy sessions per year as well as treatment for substance abuse. The Essential Health Benefits of the ACA helped correct this discrepancy.

It’s safe to say that mental health care isn’t a safety net for those with mental health challenges; it’s a lifeline. It’s not just for the millions directly affected, but for the huge population it touches obliquely.

A full 1/5th of the US population, 43.8 million Americans, experience mental illness in a given year (some estimates have the figure at 1/4th of the population). Consider also that 1 in 25 Americans, 9.8 million people, have a mental illness severe enough to interfere with or limit a major life activity. The breadth for those affected is staggering, but the costs associated with these conditions are appalling. Each year, serious mental illness robs Americans of $193.2 billion in lost earnings.

The toll can also be measured in other, more human losses. Each day, 113 Americans die by suicide. It is the 10th leading cause of death in every age group. The CDC estimates that those 41,000 deaths each year cost the country more than $51 billion in medical costs and lost work.

The denial of insurance and Medicaid coverage will have profound, far-reaching consequences for Americans coping with mental illness. While it’s difficult to ascribe financial estimates to the GOP’s replacement plan, we do know that with less funding for Medicaid this will mean less help from mental health professionals, such as psychotherapists; fewer appointments with psychiatrists, who can prescribe medication for those who badly need it; and less money for that medication.

One of the main features of the ACA was the ban on denying or charging those with preexisting conditions more for coverage. Below is a list of mental health conditions that could potentially lead to denial of coverage or an increase in premiums, depending on the insurer’s definition. The preexisting conditions below, however, were previously used universally to deny coverage before the passage of the ACA:

• Alcohol or drug abuse with recent treatment
• Alzheimer’s/dementia
• Anorexia
• Anxiety
• Bipolar Disorder
• Bulimia
• Depression
• Obsessive Compulsive Disorder
• Schizophrenia

Again, depending on the insurer, those affected could also potentially pay more under the new GOP plan for:

• Postpartum depression
• Seasonal Affective Disorder

The proposed “replacement” for the ACA means slashing Medicaid budgets by $880 billion and 24 million people losing Medicaid coverage. In 2011, individuals with behavioral health diagnoses accounted for $131 billion in Medicaid spending, almost half of that budget. Medicaid currently offers health insurance for almost 60 million low-income adults, children, pregnant women, seniors, families and people with disabilities, including some types of mental illness. It is the biggest payer for mental health services in the US, covering 27% of mental health care for Americans. Medicaid is vital to the mental health — conditions affecting the population indiscriminate of political affiliation — of low-income people across the country.

These cuts will have a dire effect on our most vulnerable populations. It will make the country less secure, more sick, and dramatically impact the well-being of large swaths of Americans. It costs us peace of mind in the immediate future and will account for billions of dollars in lost productivity, unreimbursed emergency room visits, and loss of life.

If you feel strongly about protecting mental health services and access to care, or are worried about the implications of the AHCA, please call your elected representatives.