When the Affordable Care Act (“Obamacare”) was passed into law seven years ago, it signaled a fundamental change in America’s healthcare system. After all, in every other first-world, industrialized nation, healthcare is a basic right of citizens. Only in the U.S. has healthcare been seen as primarily a business — one where profits can be put before people’s health.
Now as the Republicans seek to unmake Obamacare with a “repeal and replace” effort, questions have are arising about how exactly this will impact individuals — both those who depend on Obamacare as a lifeline to affordable healthcare and those who don’t. There’s a lot of fear and misinformation out there right now, so I’d like to set the record straight.
First, let’s acknowledge that in no way, shape, manner, or form will Obamacare be repealed in its entirety in a single session of Congress. The Republicans and president-elect have both acknowledged there are lots of good things in Obamacare that they’re keeping. So when they say “repeal,” they actually mean, “we’re going to remove the provisions of the law that we don’t like.” (That’s certainly not repealing as the term is commonly defined.)
Here’s what is likely staying (I say “likely,” since Congress hasn’t actually delivered anything that will change Obamacare yet):
- Pre-existing conditions will likely continue to be mandated to be covered
- Adult children will likely be able to remain on their parents’ healthcare plan until age 26
- No lifetime limits on healthcare will stay in place — for now
- Pharmaceutical companies will continue to have to report payments made to physicians
- The major reforms made to Medicare that reduced payments to hospitals and private insurance companies will likely stay
Here’s what is likely changing through new legislation yet to be introduced by Republicans:
- Subsidies to help pay for health insurance will be eliminated and replaced with tax credits or a tax deduction for buying insurance
- Healthcare insurance will no longer be required to be purchased by everyone (both individual and corporate mandates will be removed)
- There will be no tax penalties or fines if a person doesn’t have health insurance
- Essential, minimum health benefits that an insurance plan must cover will likely no longer be defined or mandated
- Medicaid funding increases to the states will likely be rolled back (e.g., cut), and the states will likely be given more control over the funding they do receive
According to various news reports, the Republican Congress will likely move forward with piecemeal legislation to address the specific issues noted above — the things they want to remove from Obamacare.
Of course, this is all just informed speculation at this point. Neither Congress nor the president-elect have put forward their own plans yet (although the GOP previously published a healthcare replacement plan last year detailing what the party would like to do). Until the GOP does, we’re left with a lot of anxiety about how the government might take away benefits now enjoyed by millions of Americans.
How This Will Impact Mental Health
Assuming the above forecast is close to what happens, there are both wins and losses for people with mental health concerns. The biggest potential win is if Republicans keep coverage of pre-existing medical conditions in the law. Because mental illness can often be a chronic condition, it’s patently unfair for insurance companies to treat it as a “pre-existing” condition. If this provision gets removed in new legislation, it would have the biggest negative impact on those with mental illness.
Cutting back the Medicaid expansion will have a big impact on many with mental illness, since more than 25 percent of Medicaid spending goes toward the treatment of mental illness and substance abuse. At a time that we’ve been lobbying time and time again for the government to increase treatment funding, this would be a major blow to the poor who rely on Medicaid as their health insurance.
Promises Made, Promises Broken
Remember President Obama’s 2009 healthcare promise made in his weekly address?
“If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold.”
Well, the Republicans have made a similar promise: “Republicans have pledged that no one who has insurance through the ACA will lose it,” according to NPR.
History has shown that Obama over-promised — people lost their doctors, lost their plans, and costs — including premiums — have skyrocketed. Could the Republicans be making the same mistake?
Even if they aren’t making the same mistake, one has to ask: What’s the use of a healthcare plan such as Medicaid if no health care provider will see you with that kind of coverage?
For further information
New York Times: The Biggest Changes Obamacare Made, and Those That May Disappear