How Trumpcare Will Affect Mental Health

The American Health Care Act — aka Trumpcare or the AHCA — is the GOP’s effort to “repeal and replace” the Affordable Care Act (aka Obamacare). You’d think with a proponent like Trump behind it, it would offer the gold standard of healthcare. You know, like the free healthcare that Congress gives itself.

Instead, the proposed law is a fairly half-hearted attempt to remake the Affordable Care Act into something that Republicans can better stomach. Let’s take a look at the current proposal, which is getting pushback from all sides.

President Trump has repeatedly referred to the Affordable Care Act (ACA), passed more than seven years ago, as “the disaster known as Obamacare.” Now he has his own disaster-in-the-making to defend, proclaiming in late February, “Nobody knew healthcare could be so complicated.” (Actually, anyone who’s worked in healthcare or been in a hospital in the past 10 years knows exactly how complicated it is.)

Remember, apparently devoid of any understanding of the complexities of the healthcare system in the U.S., Trump nonetheless promised Americans a better system:

On 60 Minutes in September of 2015, Trump vowed that everyone would be covered if he won. “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

Pressed for specifics, he explained that “people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.” …

“You will end up with great health care for a fraction of the price and that will take place immediately after we go in. Immediately! Fast! Quick!”

So what are we getting instead?

Trumpcare Analyzed & Dissected

In January, I gave you the lowdown of what Trump’s and the Republican’s new plan would likely look like. As predicted, the new proposal is nothing like a “repeal and replace” — it’s simply a change to the existing law. Coverage of pre-existing conditions and coverage under your parents’ plan until you turn 26 will remain. The requirement that insurance companies offer their minimum plan covering 10 essential benefits remains. And there will continue to be a ban on lifetime and annual limits for healthcare treatment.

However, if you stop healthcare coverage for any reason (e.g., you change jobs, can’t afford it temporarily, etc.), the Republicans will let the insurance companies fine you big time — up to a 30 percent insurance premium penalty. So instead of fining you for not having coverage under the ACA, they’ve just moved the fine from the government to private companies — the consumer still gets penalized.

The GOP’s new plan relies on tax credits and health savings accounts to help with the cost of health insurance. But the credits offered will be significantly lower than offered under the current plan — meaning most Americans will end up paying more for their insurance. How that equals “great health care for a fraction of the price” escapes my comprehension. The old plan offered subsidies based upon income; under the new plan, the tax credits will instead be based on age.

The interstate insurance competition Trump touted on the campaign trail is absent in the current version of the bill. That means no more choices for Americans than they have today. (Trump has promised this will happen at some point in the future instead.)

The healthcare exchanges will stay — for now. These exchanges allow people who couldn’t otherwise afford to buy insurance to do so, although the choices are often limited to a single insurer offering bare-bones healthcare plans.

Medicaid will also stay the same — for now. Then in 2020, the plan is to move away from open-ended entitlements in Medicaid and switch to a per-person allotment to the states. This eventual change would likely have a devastating impact on the people who are covered under Medicaid — generally the poorest American citizens. The cap per individual in 2020 would be based upon how much funding the state was receiving in 2016. This effectively means the states will be working with 4-year-old, insufficient budgets — all the while healthcare costs continue to climb.

Worse things happen after 2020, too, especially if you have a mental illness or substance abuse problem and use Medicaid to get your treatment. Beginning in 2020, the proposed GOP plan would eliminate the current requirement that Medicaid cover basic mental-health and addiction services in states that expanded it. Instead, the feds will allow each state to decide whether to include those benefits in Medicaid plans. In order to keep their Medicaid costs down, many states would rollback such coverage. Goodbye opiate addiction treatment.

And completely unrelated to “fixing” the ACA, the new bill would cut off all federal funding to Planned Parenthood, long a pet-peeve of Republicans who don’t like that the woman’s health care clinic — in addition to all the other services they provide — also provide abortions.1

The Trumpcare Upshot: Doing With Less

Unlike the gold standard healthcare plan offered to members of Congress, Americans are now being offered a stripped down version of the ACA. As I wrote in 2014, the Affordable Care Act results in increased utilization of treatment. Combined with its subsidies and getting rid of pre-existing condition denials, the ACA has been a boon for mental illness treatment in America.

Trumpcare, on the other hand, will roll back many of these benefits, and appears to do little to rein in healthcare costs — Republicans biggest complaint about Obamacare. Instead, it focuses on cutting federal spending in support of the plan, with nothing offered to help control spiraling costs (and profits!).

The new plan proposed is pretty much what we expected, and so we’re not surprised by what was offered. What remains to be seen is how much the new plan would cut federal spending versus the existing ACA (because the non-partisan Congressional Budget Office hasn’t yet released estimates about the new plan) and how many Americans will likely lose insurance due to these cuts.

But Trump tweeted on March 7, 2017 that the new Trumpcare plan was “wonderful:”

Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!

Trump is clearly going back on his campaign promises to “take care of everyone” no matter what the cost. It’s clear the new plan offers Americans nothing new and will likely end up costing most Americans more money, while offering less coverage.2

What is clear is how much of a “complete and total disaster” the new plan, as written today, would be for people struggling with mental illness or substance abuse. The cut over time in Medicaid funding — where millions of Americans get their care for mental illness or substance abuse — would hurt our most vulnerable population of citizens. The list of groups against the new plan — including many conservative Republicans grows by the day. Both the AMA and AARP are against the new plan, among dozens of other organizations who’ve taken a stand.

Psych Central doesn’t see any benefits provided by the new plan, but does see the potential for a lot of harm and millions of Americans losing their mental health care coverage. Therefore we adamantly oppose Trumpcare.

As President Trump might tweet, we only have one reaction to Trumpcare: “SAD!”

 

For further information

New York Times: The Parts of Obamacare Republicans Will Keep, Change or Discard

New York Times: House Republicans Unveil Plan to Replace Health Law

USA Today: Republican Health Care Bill Facts

Text of the new law: Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable
Care Act

Footnotes:

  1. Abortions are perfectly legal in the U.S. and a necessary component of woman’s healthcare services — but opposed by many conservatives. []
  2. I’m also not clear on how something that is a “complete and total disaster” still keeps many of its primary provisions intact, even after the AHCA plan is passed? []