The Affordable Care Act

The Affordable Care Act (ACA) extended health insurance coverage to millions of Americans. Many individuals with mental health or substance use disorders were able to obtain coverage, some for the first time, thanks in large part to the ACA's prohibition against individuals with pre-existing conditions, the requirement that insurers must cover certain benefits, and its expansion of Medicaid eligibility. However, efforts to repeal, limit, or undermine many of the ACA's protections are ongoing.

In 2017, several unsuccessful attempts were made to repeal the Affordable Care Act (ACA), with and without a replacement plan; APA opposed these efforts and will continue to do so in the future. APA also opposes ongoing litigation seeking to declare the ACA unconstitutional, as well as various administrative efforts to undermine the ACA's consumer protections or destabilize the ACA-created insurance marketplaces.

APA continues to advocate on behalf of APA members and patients in coalition with allies in the physician and mental health communities on this issue. Many proposals adopt a variety of strategies to expand or lower costs of coverage (i.e. stabilizing the ACA's marketplaces, Medicare or Medicaid buy-in options, or single-payer "Medicare for All"-style systems). APA will continue to evaluate the merits of these proposals according to its stated priorities on coverage, benefits, and consumer protections.

Introduced Nov 2017

Individual Mandate Repeal

As part of the Tax Cuts and Jobs Act, the Senate and House included provisions repealing the Affordable Care Act's individual shared responsibility mandate, with the House also including a provision repealing the medical expense deduction.

Introduced Oct 2017

HHS Religious Exemption RFI

The Department of Health and Human Services requested information and comments on removing barriers for religious and faith-based organizations to participate in DHHS programs and receive public funding. This proposal would create religion-based exceptions that would allow providers to discriminate against Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) patients.

Introduced Oct 2017

Alexander-Murray & Stablization

The Murray-Alexander bill contains numerous provisions that would have an impact on the ability of individuals to access treatment of mental illness and substance use disorders. They are summarized here. Overall, the bill contains a two-year appropriation of CSR funding, includes increased funding for ACA Enrollment Outreach and Assistance, accelerates Section 1332 Waiver Process while maintaining its core coverage requirements and consumer protections, and allows broader enrollment in catastrophic plans.

Introduced Sep 2017


In September 2017, Senators Lindsey Graham and Bill Cassidy released their repeal and replace legislation that would have imposed a per-capita cap on federal Medicaid funding, ended Medicaid expansion available under the ACA, and reduced federal funding for private insurance tax credits and subsidies by converting them into a single block grant to the states. After several key Senators announced their opposition to the bill, Senate Republican leadership announced on September 26th that it would not hold a vote on the bill.

Introduced Jul 2017

Skinny Bill

When BCRA did not have enough votes to pass, the Senate majority tried advancing a scaled-down version of BCRA known as the "Skinny Repeal Bill." It contained minimal repeal measures that would have primarily repealed the ACA's employer and individual mandates, which would have destabilized the individual insurance market. According to the CBO, the Skinny Bill would have increased the number of uninsured by 16 million people in 2026. It failed by a vote of 49-51 on July 28th, with important deciding Republican votes from Senators Collins, McCain and Murkowski.

Introduced Jun 2017


BCRA, the Better Care Reconciliation Act, was the Senate’s attempt at repeal and replace of the Affordable Care Act (ACA). Similar to the AHCA, BCRA would have ended expansion of Medicaid eligibility, made substantial cuts and changes to federal funding of the Medicaid program, and enhanced states' ability to waive the ACA's coverage requirements and consumer protections, which would have had an impact on the practice of psychiatry and the treatment of individuals with serious mental illness and substance use disorders. It failed by a vote of 43-57 on July 25th.

Introduced Mar 2017


H.R. 1628, the American Health Care Act, was the House-passed version of repeal and replace. According to the CBO, AHCA would have left 24 million fewer Americans with coverage by 2026. The legislation would have had a substantial negative impact on individuals with mental illness and substance use disorders by reducing Medicaid funding by converting it into a block grant to states, increasing private insurance costs for older individuals and individuals with pre-existing conditions, and allowing states to establish their own standards for essential health benefits. The AHCA narrowly passed the House on May 4th.

Additional Resources