The process will not in fact eliminate the ACA. The current action takes place under complex rules in the House and Senate limited to spending and revenue. This “reconciliation” process requires only a simple majority to pass legislation. To repeal other provisions of the ACA that do not have a direct budgetary impact, the Congress must eventually pass separate legislation that requires a 60-vote majority in the Senate, enough to overcome a filibuster.
“While a number of details about the potential impact of the proposed ACA replacement remain unknown, our current understanding of the proposal raises many concerns for people with mental illness,” said APA President Maria A. Oquendo, M.D., Ph.D., in a statement.
Major changes to Medicaid are particularly worrisome because almost one-third of people receiving coverage through Medicaid expansion have mental health or substance use disorders, noted Oquendo.
The new plan would repeal coverage of “essential health benefits” required in Medicaid expansion plans under the ACA. Such a change would give states the option to end guaranteed treatment for mental health and substance use disorders, thus threatening parity. Other provisions would roll back Medicaid expansion and limit a state’s Medicaid per capita spending.
The law also would eliminate cost-sharing subsidies and the individual mandate to buy insurance, while requiring a 30% surcharge for individuals who have been uninsured for more than 63 days in the preceding 12 months. Such a provision would disproportionately affect low-income individuals and people with mental illness, who are more likely to go without insurance.
The bill retains some valuable provisions of the ACA, like covering preexisting provisions, capping out-of-pocket expenditures, and covering adult children up to age 26.
The legislative process now under way is likely to be complex and contentious, while packed into a compressed work schedule. The House and Senate took more than a year to consider the ACA, but Republican leaders have signaled a desire to move the American Health Care Act through both houses in a matter of weeks.
“APA is committed to working with members of both parties in Congress to help ensure adequate access to quality mental health care for all those in need,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in a statement.
For more in Psychiatric News about health care legislation, see The Future of the ACA by APA President Maria A. Oquendo, M.D., Ph.D.