Republicans in the House revealed a replacement plan for the Affordable Care Act last week. It remains to be seen whether the “American Health Care Act” will become the law of the land — after the non-partisan Congressional Budget Office estimated that it would leave an additional 24 million Americans uninsured by 2026,it must still pass the House and Senate and get President Donald Trump’s signature. In the meantime, it’s the only tangible replacement to Obamacare that’s on the table. So what would the act mean for Americans with mental-health diagnoses, such as depression and substance use disorders? Below, three major takeaways:
1. Insurance Companies Would Still Have to Cover Treatment for Mental-Health Disorders — but State Medicaid Plans Might Not
In 2015, Obamacare created and implemented what it called the “10 essential health benefits,” which includes mental-health services and addiction treatment. Under the American Health Care Act, all the plans that companies sell in the individual marketplaces must continue to cover these essential benefits.
In 2020, however, the American Health Care Act would allow states to stop covering the 10 essential benefits for people who became insured under Obamacare’s Medicaid expansion. Those individuals may then have to begin paying for services like addiction treatment or overdose-reversing drugs out of pocket, even if they’re insured.
2. Obamacare’s Medicaid Expansion Would Come to a Halt, Which May Disproportionately Affect Those With Addictions to Prescription Painkillers and Heroin
Obamacare made more Americans eligible for Medicaid, so long as their states opted into the expansion. Eleven million adults gained Medicaid coverage this way, according to a Kaiser Family Foundation analysis. Under the American Health Care Act, in 2020, Medicaid requirements would become stricter, once again, for new enrollees. In addition, any adult who gained Medicaid under the expanded rules can keep their coverage, but only if they remain insured with no gap lasting longer than one month.
Addiction-care advocates say these rules may hurt many who are getting treated for an opioid use disorder. The five states hardest-hit by opioid overdoses in 2015 — West Virginia, New Hampshire, Kentucky, Ohio, and Rhode Island — all expanded Medicaid. Medicaid pays for 44 percent of buprenorphine-based opioid addiction treatment in Kentucky; 45 percent of it in West Virginia; and 49.5 percent of it in Ohio, the Washington Post reports.
It’s not known exactly how many of those people would lose their Medicaid coverage should the American Health Care Act pass. (Remember, those who benefited from the expansion can keep their coverage, so long as they stay insured.) University economists estimate that almost 1.3 million Americans are getting mental-health, including substance use disorder, treatment through the Medicaid expansion, according to the Post.
3. Insurance Companies Still Wouldn’t Be Able to Discriminate Based on Pre-Existing Conditions, Which Is Good for Those With Mental-Health Diagnoses
The American Health Care Act keeps intact Obamacare’s “pre-existing condition” ban. Before Obamacare, behavioral-health disorders were the second-most common pre-existing condition insurance companies would use to charge people higher premiums or to deny them plans, the Department of Health and Human Services estimates.
The Bottom Line
Under the American Health Care Act, many protections would remain for the estimated 43 million American adults who have some mental-health condition. Among those who have the most to lose may be people who got covered under Medicaid when their states expanded eligibility, namely those who earn a bit more than federal poverty wages.