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In a letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.) dated June 6, the two mental health associations expressed their reservations with the House bill passed May 4.
“We strongly oppose the American Health Care Act, as recently passed by the House. According to the Congressional Budget Office, the AHCA would result in 14 million more people uninsured in 2018 than under current law, and 23 million more people without insurance by 2016,” wrote APA CEO and Medical Director Saul Levin, M.D., M.P.A., and American Psychological Association CEO and Executive Vice President Arthur C. Evans, Ph.D. “Millions more would lose access to treatment, with mental health and substance use services no longer being covered under their benefit package. This is the wrong direction for our country.”
Levin and Evans called on the Senate to retain Medicaid eligibility for Americans below 138 percent of the federal poverty level and to retain the current Medicaid financing structure, without the use of per capita caps or block grants.
“Low-income and uninsured adults have sharply higher rates of serious mental illness as those with insurance and higher incomes,” they wrote. “Medicaid expansion has been particularly helpful in addressing the opioid epidemic, as illustrated by the 700 percent increase in use of substance use treatment services among Kentucky beneficiaries after the state expanded its Medicaid program, and Medicaid’s coverage of 37 percent of spending on buprenorphine in New York.”
The opioid epidemic illustrates the danger of capping federal Medicaid payments, they said. “Private insurance payments for opioid abuse and dependence services increased by 1,375 percent between 2011 and 2015 (from $32 million to $446 million),” they wrote. “Under a system of Medicaid per capita capped payments, tens of thousands of individuals struggling with opioid addiction would have been denied Medicaid coverage and treatment, and thousands more would have died. … States already have significant flexibility in tailoring their Medicaid programs, and can be provided more flexibility without capping federal payments.”
Levin and Evans urged the Senate to also continue to require plans to cover an essential health benefits package that includes mental health and substance use disorder services and behavioral health treatment, and to prohibit insurers from charging higher premiums for people with pre-existing conditions. Further, the pair emphasized the importance of continued investment in research and programs, including retaining the Prevention and Public Health Fund.
“Our nation cannot afford to go back to the days when insurers selectively enrolled individuals to avoid financial responsibility for needed services. Nor can we afford to return to viewing mental health and substance use services as optional,” the leaders wrote. “Rather, we must further reduce the uninsured rate, develop integrated systems of care, and continue to foster an environment in which health plans compete on how efficiently and effectively they can provide services.”
Write Your Senators and Urge Them to Start Over on AHCA
APA members are urged to contact their senators to express opposition to the AHCA and instruct the Senate to set aside the House bill and start over on new legislation that does not put at risk health care for people with mental health/substance use disorders. To make such communication quick and easy, visit the APA Advocacy Center.
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