After reviewing the Senate Republican proposal that would repeal and replace the Affordable Care Act (also known as “Obamacare”), the American Counseling Association (ACA) is joining other healthcare advocacy organizations in opposing this bill. The “Better Care and Reconciliation Act of 2017” (BCRA), as the repeal/replace bill is officially called, simply creates too many uncertainties in the delivery of, and access to, mental health and substance abuse treatment. Chief among these concerns are the increase in the cost of insurance, the number of persons that could lose coverage, and the cuts to Medicaid.
Shortly after the BCRA was introduced, the Congressional Budget Office (CBO) released its analysis of the impact the legislation would have if adopted. According to this report, an estimated 22 million more Americans would lose their insurance by 2026 than are covered under current law. As an organization that is dedicated to increasing access to mental health services for all Americans, this statistic is deeply troubling. The BCRA could adversely affect the 1 in 5 Americans who are struggling with mental illness.
While the BCRA does not specifically call for the elimination of essential benefits that are mandated under the Affordable Care Act, the proposed legislation does allow states to apply for a waiver that would allow them to set their own minimum benefits. This could mean that mental health benefits would no longer be offered in some insurance plans, or that plans that do offer those benefits would become inordinately expensive. In fact, a recent study shows that, in 2013, before the essential benefits became mandatory under the Affordable Care Act, mental health services were not covered in 38 percent of individual plans and outpatient substance abuse services were not covered in 45 percent of individual plans. Under the BCRA, state Medicaid programs and private insurers could return to providing only short-term, minimal treatment for substance abuse disorders and mental health, if they provide any coverage at all.
Perhaps the most troubling aspect of the BCRA is the proposed cuts to the Medicaid program. The CBO noted that Medicaid funding could be cut by as much as 26% by 2026. The CBO also estimated that, if the BCRA’s proposed change in Medicaid’s inflation factor takes place in 2026, Medicaid funding would be 35 percent lower at the end of the next decade compared to current spending. As many Licensed Professional Counselors know, a large portion of their clients are only able to access mental healthcare through Medicaid. Without that funding, critical care for these Americans would be unattainable. When the per-capita limit on Medicaid funding is factored in, those services become more out of reach for the Americans that require them the most. Additionally, Medicaid cuts jeopardize efforts to combat the nation’s raging opioid epidemic.
The American Counseling Association is fully aware of the monumental tasks that the Congress and the Administration face in ensuring that all Americans have access to healthcare. We have faith that congressional leaders and the President are fully invested in finding solutions to the problems in our healthcare system. Indeed, over the last few years, we have worked with Republican officials to increase access to mental healthcare for veterans, military families, and students in our nation’s schools. We at ACA remain committed to working with the Administration and the Congress to expand access to care—and to improve the quality of care. We simply do not believe the Better Care and Reconciliation Act is the best approach for reaching these goals.