Monday, June 26, 2017

APA Releases Overview on Impact of Senate Health Bill on Psychiatry

Within a matter of days, the Senate could vote on the Better Care Reconciliation Act (BCRA)—the bill unveiled last week by Senate Republicans to repeal and replace the Affordable Care Act (ACA) and make significant changes to the Medicaid program. 

Tucked within the 142-page discussion draft of BCRA are numerous provisions likely to affect Americans with mental health and substance use disorders. APA’s Government Relations team has created a three-page fact sheet summarizing how BCRA might affect access to and the delivery of mental health and substance use disorder treatment services. 

As described in more detail in the fact sheet, BCRA would cap federal funding for state Medicaid programs on a per-beneficiary basis, phase out the Medicaid expansion made available to states under the ACA, and add administrative costs and burdens to Medicaid. BCRA would also allow states to waive the federal requirements that plans carry certain essential health benefits (EHB)—a change the fact sheet notes “could affect large employer plans, which are only prohibited from imposing annual and lifetime limits on EHB and only required to cap out-of-pocket expenditures for EHB.”

“Eliminating requirements for coverage of key benefits, including mental health and substance use disorders and other patient protections that are part of the Affordable Care Act, will have detrimental impacts for millions,” said APA President-Elect Altha Stewart, M.D., in a press release issued by APA last week. “Mental health is critical to overall health and needs to be equally accessible.”

Additional provisions affecting access to and delivery of evidence-based mental health and substance use disorder treatment services include the following:

  • BCRA would create a one-time appropriation of $2 billion in FY 2018 to HHS “to provide grants to States to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders.” This amount is much less than was offered in the House version of the bill, known as the American Health Care Act (H.R. 1628), which passed the House on May 4.
  • BCRA would repeal the Prevention and Public Health Fund, which is a significant source of funding for programs administered by the Substance Abuse and Mental Health Services Administration. 
  • States may include inpatient psychiatric services as an optional benefit in their Medicaid plans for individuals aged 21 to 65. The bill also provides a lower match for such services (50 percent) furnished on or after October 1, 2018.

“The Senate proposal represents a significant move in the wrong direction, resulting in fewer people having access to insurance, fewer patient protections, and less coverage for essential behavioral health care,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in the press release. “We urge the Senate to reject this harmful legislation and start again on a health care bill that puts patients first.” 

The House version of the bill, according to the Congressional Budget Office (CBO), would leave some 14 million more Americans uninsured next year than under the current law and 23 million more uninsured by 2026. The Senate bill awaits CBO analysis.

Your Voice Counts
APA urges you to contact your senators and speak out against the Senate health care reform bill released today. APA has created a dedicated tool to make it easy for you to voice your opinion via Facebook, Twitter, or phone.

(Image: iStock/flySnow)


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