By Lindsay Wallace, Executive Director
Since the election of President-elect Donald Trump, many of you have reached out to the NAMI Dane County office asking what it means for mental health, particularly because one of his campaign promises was to repeal and replace the Affordable Care Act (ACA).
The ACA as it currently stands includes provisions that provide enormous protections for people with mental illnesses and substance use disorders. The areas in which repealing the ACA could potentially impact the people we serve includes repealing essential health benefits and removing the expansion of Medicaid eligibility requirements. However, there are provisions within the bill that the President-elect supports, including allowing young adults to stay on a family insurance plan until the age of 26.
NAMI Dane County's biggest concern is the potential repeal of essential health benefits. This was a major win for people with mental illnesses and substance use disorders when the ACA was implemented as it required insurance companies to have discrete coverage for these disorders - even in the small group and individual insurance markets.
Prior to the ACA, insurance companies were exempted from covering essential health benefits. Thus, if repealed, we would see coverage of mental health and substance use benefits dwindle, with higher deductibles. Additionally, insurance companies would have more control in choosing what mental health and substance use services they wanted to cover.
We are uncertain about what will happen with Medicaid expansion but if it is repealed, a lot of states could lose federal dollars. Though Wisconsin did not expand Medicaid, we still have concerns. Medicaid provides the infrastructure for public health funding thus repealing it could have catastrophic implications for many people across the nation as Medicaid is the primary insurance provider for people with serious mental illnesses. Medicaid is much more comprehensive than private insurance so we need to work as hard as we can to preserve Medicaid coverage for those states directly impacted by fewer federal dollars currently being funneled into their mental health and substance use delivery system.
When the new Congress takes office on January 3, 2017, we can expect them to aggressively move on repealing and replacing the ACA. You might be asking if NAMI can stop this bill from moving forward and the answer is no. However, it is important to note that the bill would not go into effect right away. It could be as long as 3-4 years before we see any changes. We also don't know what is in the replacement bill, which means at this point it is mostly speculation.
We do know that President-elect Trump has supported the possibility of changing the structure of Medicaid by converting it to block grants, which could be part of a replacement bill. The problem with Medicaid block granting is that it would slash federal funding and shift the cost to states. As a result, it would push states to cut their Medicaid programs deeply.
Further, states could impose a work requirement and terminate coverage for those who do not comply. Many people with serious mental illnesses face significant barriers to employment, such as access to child care or transportation, difficulty coping with basic tasks, and limited education or skills. Thus, a work requirement could mean leaving many of the people we serve without insurance coverage for much needed mental health and substance use services.
Again, we do not know what will be included in a replacement bill so conversion of Medicaid to block grants is largely speculation. With strong bipartisan support for enhancing mental health and substance use services, evidenced through the passage of the Mental Health Reform Act on a vote of 94-5, we need to leverage the fact that Congress cares and remind them how important Medicaid is to publicly funded mental health care and substance use services.
Please know that we are not alone; there are lots of other organizations involved and we are part of those coalitions. Together, we can make a difference and ensure our voices are heard.
NAMI Dane County is a nonpartisan organization and the concerns we note here do not mean we are promoting the ACA as it currently exists nor are we endorsing a specific political candidate. What we will continue to do as we have over the last 40 years is pursue and advocate for policies that enhance coverage and services for the people we serve.