APA Concerned About Proposed ACA Replacement Bill

ARLINGTON, Va. — The American Psychiatric Association (APA) is deeply concerned that the proposed ACA replacement released last night will negatively impact care for people with mental illness and substance use disorders. The APA urges continued support and expanded access to quality, evidence-based mental health and substance use services.

Mental illness is prevalent in the United States. According to the National Institute of Mental Health, more than 68 million Americans experienced a psychiatric or substance use disorder in the past year. Depression alone has an annual negative economic impact of $210.5 billion.

It is unknown how many people will lose coverage under this proposal, but discussions on implementing significant reforms to the current Affordable Care Act and Medicaid raise the possibility that a large number of people with mental illness or substance abuse disorders will lose some or all of their coverage.

“While a number of details about the potential impact of the proposed ACA replacement remain unknown, our current understanding of the proposal raises many concerns for people with mental illness,” said APA President Maria A. Oquendo, M.D., Ph.D. “Particularly concerning are proposed changes to the Medicaid expansion program. Nearly one-third of people receiving coverage through Medicaid expansion have mental health or substance use disorders.”

As efforts are made to reform the health system, services for people with mental health and substance use disorders – and their families – must be maintained. We cannot bring down the cost of health care without fully addressing mental health and substance use disorders issues. The American Psychiatric Association offers the following recommendations:

  • Maintain the current level of coverage for mental health and substance use disorders in health insurance plans.
  • Maintain safeguards in private insurance by specifically prohibiting the following:
    • Denying coverage based upon a pre-existing condition;
    • Establishing lifetime and annual dollar limits on essential health benefits; and
    • Discrimination based upon health status, including a history of mental illness or substance abuse.
  • Any efforts to restructure Medicaid must ensure sufficient funding for mental health and substance use issues and not shift the cost to states in a way that forces them to tighten eligibility requirements, provider reimbursement, or benefits.
  • Ensure full implementation and enforcement of the bipartisan Mental Health Parity and Addiction Equity Act, which calls on insurers to offer coverage for mental health care on par with coverage for any other ailment.

The APA notes that the replacement bill, the American Health Care Act, keeps some positive provisions of the Affordable Care Act intact, such as the provision that allows for preexisting conditions and allowing young adults to stay on their parents’ plan until age 26.

“As Congress considers reforms to health insurance coverage it is critical to maintain the significant progress made over the past three years, through bipartisan efforts, to improve access to mental health care,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA is committed to working with members of both parties in Congress to help ensure adequate access to quality mental health care for all those in need.”

The American Psychiatric Association is a national medical specialty society whose 37,000 physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders.

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