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How Last Night’s Obamacare Votes Could Affect Addiction Care

In a first step to repealing the Affordable Care Act, Senate Republicans struck down two provisions that are considered crucial to expanding substance use disorders and other mental-health care in the United States.

By Francie Diep


Senate Majority Leader Mitch McConnell. (Photo: Win McNamee/Getty Images)

In a wee-hours vote last night, the Senate passed a budget that paves the way for an Obamacare repeal. As they voted, Senate Republicans struck down numerous amendments Democrats offered to preserve parts of the Affordable Care Act. Two of the amendments Senate Republicans voted against are important for expanding mental-health services in the United States and combating the opioid epidemic, including:

  1. The ban on companies from raising people’s premiums or denying them coverage based on their pre-existing conditions. Before Obamacare, behavioral health disorders — which would include addictions — were the second-most common pre-existing condition companies considered, the Department of Health and Human Services estimates. Rounding out the top five were high blood pressure, high cholesterol, asthma, and arthritis.
  2. Extra Medicaid funding. Thirty-two states expanded Medicaid under the Affordable Care Act. Such states saw an especially steep drop in the proportion of people who were hospitalized for mental-health disorders, but didn’t have insurance to help them pay for it, according to Health and Human Services data. The numbers went from one in five in 2010, to less than one in 15 in 2014.

The repeal budget will now go to the (also GOP-controlled) House of Representatives, on Friday. Some of the proposals Republicans have offered as a replacement for the Affordable Care Act would restore pre-existing conditions protection and Medicaid expansion. But it’s still unclear which replacement plan lawmakers will agree to use, and when it will go into effect.