The health care reform bill that passed the U.S. House of Representatives last week promises sweeping changes to the provisions of the Affordable Care Act. While a lot of attention has focused on things like pre-existing conditions, one of the less considered issues is what may happen to the treatment of mental illness and substance abuse.
The biggest threat to treatment for mental illness and substance abuse issues comes from the rollback of Medicaid that would happen under the Republicans’ health care bill.
Federal spending on Medicaid would be cut by $880 billion over the next ten years.
As states try to fill that gap, advocates for mental health and addiction services believe those treatments could be first in line for cuts. That could potentially devastate the effort to fight the opioid crisis, as one example.
The American Psychological Association estimates that Medicaid currently covers at least 25 percent of all mental health treatment in the US.
But it’s not only in low-income communities that problems could arise. Under the Republicans' AHCA, individual states could allow private insurers to opt out of providing certain benefits, including coverage for mental health treatment.
Daniela Giordano of the National Alliance on Mental Illness in Connecticut said that even people in "blue" states, which have pledged not to take advantage of the provisions, may not be immune from changes in the future.
“Things could change in Connecticut, where decision-makers may not be as clear and strong in their position that they wouldn’t go for those waivers that states could do under the federal proposal,” she told WNPR.
Giordano said advocating for mental health treatments can be a challenge, but she and other activists are focusing on the Senate now, which is next to take on health care.
She said they hope to bring home to lawmakers the human cost of rolling back protections.
"It’s not just a health issue. It has implication on how we function in life," said Giordano. "I think that’s what legislators need to hear more of: those personal stories of what that means to people, of how well things can go when they have access to services and supports and benefits, and how badly things can go when they don’t."
She and others fear that early, effective intervention and low-cost treatments for people suffering from mental illness and substance abuse may become a thing of the past under the Republican plan.
Republican proponents, meanwhile, have said the bill will restore choice to consumers and lower health care premiums.