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What Are the Possible Setbacks for Mental Healthcare If the Affordable Care Act Is Repealed?

In January, the U.S. Senate began the first of many steps necessary to dismantle the Affordable Care Act—acting in accordance with one of President Donald Trump’s many campaign promises. After two weeks of sweeping executive orders that have caused controversy across party lines, it appears as though repealing the law quickly may not be in the cards.

As CNN reported earlier this month, "In one faction are lawmakers increasingly wary of the pitfalls of a quick and sweeping repeal of the Affordable Care Act." The change, reporter MJ Lee writes, "has irked other Republicans who are eager to take a swift vote to roll back as much of Obamacare as possible," worried that their constituents at home will be outraged if the repeal doesn't make headway.

Trump himself seems to be taking a step back from his campaign promises. In an interview with Bill O'Reilly on Super Bowl Sunday, the president noted that overhauling the American healthcare system is "very complicated," and would not comment on a timeline when he believed an alternative would present itself.

For those that rely on The Affordable Care Act for mental health treatment, the threat of losing coverage under the ACA is extremely prevalent, especially when you consider what mental healthcare treatment was like in the United States pre-ACA.

An estimated 42.5 million Americans over the age of 18 suffer from a diagnosable mental health condition each year, and 4 percent of those Americans experience debilitating side effects that prevent them from going to school or work.

Under the ACA, private insurance plans were required to offer key essential benefits in order to remain on the market. For those diagnosed with a mental health condition, plans had to include coverage for therapy, medication, and preventable measures. In addition to those benefits, private insurance companies also had to ensure that those diagnosed with pre-existing conditions would not be denied coverage.

This is a far cry from how mental health treatment was before 2013. In the years before the ACA was implemented, a person with a mental health diagnosis was unable to obtain private insurance in a majority of states--as it was previously found to be a preexisting condition.

As the official Obama White House twitter noted in January, repealing the affordable care act would leave millions of Americans with treatable mental illnesses without insurance coverage. For many, lack of insurance means they must forego treatment.

A number of advocates have come forward in an effort to convince congressional leaders to forego repealing the ACA. The American Psychiatric Association, for example, issued a letter to congressional leaders, advocating for those with mental health and substance abuse disorders.

Writing on behalf of over 36,500 psychiatric physicians across the U.S., the APA penned that they fully supported expanded access to quality mental healthcare services for those suffering from psychiatric or substance abuse disorders, writing that ACA provisions have directly enhanced the quality of life for those diagnosed with a mental health condition.

"Individuals with bipolar disorder, schizophrenia, major depressive disorder, substance use disorders, and other mental health issues previously struggled to obtain insurance coverage to help them access care," APA President Maria A. Oquendo and APA CEO and Medical Director Saul Levin wrote. "Current law changed that by requiring coverage of necessary services to treat mental illness. Consequently, it has become less burdensome for Americans to access appropriate and evidence-based mental health care, thus improving their chance for healthier and more productive lives while reducing the stigma around mental illness."

As noted by the APA, not only did the ACA provide insurance coverage for those who had previously been without, but the inclusion of mental health services in essential benefits has also helped to reduce stigma surrounding mental illness. In a sense, requiring mandatory coverage showed, for the first time, that mental health was a critical component of holistic care.

Granted, the ACA was not a perfect solution for those coping with mental and substance abuse disorders. Despite the widespread opportunities available in the healthcare industry, a shortage of qualified medical professionals has made it particularly difficult for many patients to find a practitioner that accepts their insurance. This is particularly true in rural areas, where a lack of qualified professionals has left a dearth in medical services overall.

While other bills, such as the 21st Century Cares Act, may help ease gaps in coverage, it's clear that repealing the ACA without concrete plans to improve upon or replace the legislation would be devastating to a number of Americans regardless of their party affiliation.

As Oquendo and Levin expertly wrote in their address to congressional leaders, "As Congress considers significant reforms to health insurance coverage this year, it is critical that any such reforms do not undo the gains which have been made over the past several years for individuals with mental illness, and that any such reforms only further enhance coverage and access to lifesaving evidence-based care."

Posted by DanikaK at February 15, 2017 11:22 AM
Comments
Comment #413350

“Obamacare is in a “death spiral,” the influential CEO of Aetna, Mark Bertolini, declared Wednesday morning.

Bertolini’s doomsday prophesy: More insurers will pull out of the government-run marketplaces in the coming weeks and many areas will have no insurers to provide Affordable Care Act coverage in 2018.”

http://www.politico.com/story/2017/02/obamacare-market-death-spiral-aetna-mark-bertolini-235041

DanikaK, congress must act carefully and thoughtfully in replacing Obamacare. And, I would like to see bipartisan support for the replacement plan instead of the manner in which Obamacare was passed. There should be no bribes or threats involved by either side.

The president will have input, as he should, but it is the congress that will produce the bill. The members of congress are taking their time to try and get it right this time. I believe that is a good thing.

Posted by: Royal Flush at February 15, 2017 5:03 PM
Comment #413352

Here’s a good link for those actually interested in some of the sticking points among Republicans writing new legislation to replace Obamacare.

“Republicans determined to cut Medicaid may first have to pour more money into it to keep the peace between Republican governors who expanded health care for low-income people under Obamacare and those who resisted.”

http://www.politico.com/story/2017/02/gop-medicaid-spending-235018

Posted by: Royal Flush at February 15, 2017 5:24 PM
Comment #413364
DanikaK, congress must act carefully and thoughtfully in replacing Obamacare. And, I would like to see bipartisan support for the replacement plan instead of the manner in which Obamacare was passed. There should be no bribes or threats involved by either side.

The president will have input, as he should, but it is the congress that will produce the bill. The members of congress are taking their time to try and get it right this time. I believe that is a good thing.

I have no problem with a replacement law that gains support from a majority of both parties. Anything that decreases the number uninsured Americans is sure to gain Democratic support.

Still, the Republicans have tremendous hurdles to overcome. Namely, the threat from the HFC to refuse to support anything less than the 2015 repeal bill, which would return us to the dysfunctional system ante-Obamacare.

Regardless, I am very skeptical that Republicans can accomplish this. Democrats spent 14 long months crafting the ACA including numerous outreaches to the GOP. Every effort was made to keep as much of the health care system within the private sector in order to minimize governmental intrusion. The ACA was the best fruit of those efforts.

Posted by: Warren Porter at February 16, 2017 1:42 AM
Comment #413370

“The ACA was the best fruit of those efforts.”

It was a poisoned fruit.

Anticipating too much opposition from the insurance industry and Republicans, the Democrats gave up on the very popular “Public Option” concept very early in the legislative game. In doing so, they lost a lot of public support for the bill from the very beginning.

When the Democrats lost their 60 seat majority in the Senate, they abandoned the House bill’s national marketplace concept for state exchanges. This was a deliberate effort by the Republicans to administratively scuttle the ACA at the state level where they had control. Indeed, a majority of the Republican states refused to establish the exchanges. Predictably, the roll out of the ACA was an administrative nightmare.

What really galls me is that Republicans have claimed for years that a national marketplace (across state lines) would be a better alternative to Obamacare when they prevented that very concept during the passage of the ACA.

Posted by: Rich at February 16, 2017 11:09 AM
Comment #413375
It was a poisoned fruit.
Indeed, it was a tragic mistake for Democrats to believe that Republicans actually cared about limited government.
What really galls me is that Republicans have claimed for years that a national marketplace (across state lines) would be a better alternative to Obamacare when they prevented that very concept during the passage of the ACA.

It has been obvious for quite a while that the Republican opposition to the ACA was based on politics and not principles. They tried their best to sabotage the bill and this strategy almost worked for them.

Posted by: Warren Porter at February 16, 2017 11:58 AM
Comment #413378

Not sure how an individual mandate through a Public Option style program would have been any more accepted than the individual mandate through the ACA. Heck, moderate democrats had to be bribed to sign on to the ACA.

You take the individual mandate out of the ACA and more people would have supported it in the beginning. You take the proper amount of time and write a GOOD bill that addresses all the holes before you enact it, and maybe more people would support the ACA.

Once it’s up and running and proving itself, THEN you go for an individual mandate.

Posted by: kctim at February 16, 2017 12:56 PM
Comment #413401

kctim,

If you take the individual mandate out of any scheme, you are likely to kill the prohibition against denial on basis of pre-existing conditions. That is why Republicans are having such a hard time coming up with an alternative to Obamacare. Conservative think tanks have known this for decades. The work around requires tax payer subsidized high risk pools which have a history of failure.

We will eventually succumb to the reality of the mathematics and adopt a system like Canada’s Medicare system for all or our Medicare system for seniors. Then we might be able to work on the important issues of the health care system.

It’s important to remember that we have had for a long time a third party payer system. Obamacare simply tried to shoehorn into the system the 10% excluded from employer group insurance or Medicare with the same protections already afforded those groups.

The amount of political capital spent on this issue amazes me. The ACA addressed a very small segment of the health insurance market. It didn’t change much for the majority of Americans who get insurance through their employers or Medicare. They already had the rights against denial on pre-existing conditions and dropped coverage, etc. through the 1996 HIPPA bill.

Posted by: Rich at February 16, 2017 5:29 PM
Comment #413405

Rich,

That is why you take the time and come up with a good bill that will allow you to implement such drastic reform in tolerable steps. The ACA was absolutely a step towards single-payer, but it jumped right over steps that needed to be addressed first.

It may have addressed a very small segment, but it affected a very large segment financially. And worse, it was expected.

Posted by: kctim at February 16, 2017 5:58 PM
Comment #413436

Why is no one considering the cost of health care. The medical industry is spending money hand over fist. It appears there is no end to the amount of money they spend. They’re constantly building and buying, buying and building. I truly believe the health care industry could do with a lot less money under their control. People need to get between the health care industry and the insurance industry and demand lower charges.

Posted by: Weary Willie at February 17, 2017 11:11 PM
Comment #413438

OMFG Weary are you suggesting the private sector may be the problem with healthcare and health insurance!!


That is why you take the time and come up with a good bill that will allow you to implement such drastic reform in tolerable steps.

Where have you been the past 6 years kctim? over 40 votes in Congress to repeal Obamacare and the idiots don’t have a clue as to what to replace it with!! Exactly how much more time do you think these clowns need?

congress must act carefully and thoughtfully in replacing Obamacare.

Once again… what were these buffoons doing the past 6 years? Why on earth were they trying to repeal the ACA if they didn’t have a clue Royal?

Lets face it guys The repubs do not have a clue, they used this issue to screw the twits who believed the ACA was good but Obamacare was bad. They got the foolish to vote for them and now they are looking at each other and asking “what were we thinking”.

Posted by: j2t2 at February 18, 2017 1:04 AM
Comment #413448

Well, j2t2, since the government is not involved in healthcare and there are no laws to counter the private sector from gouging the consumer, I guess the private sector is to blame.

Posted by: Weary Willie at February 18, 2017 10:10 AM
Comment #413457

Weary, spin this for me I need to understand how this spending is the governments fault in your opinion. Medicare/Medicaid are not to blame.

Posted by: j2t2 at February 19, 2017 1:25 AM
Comment #413459

I know this isn’t related to medical spending but it does relate to how people treat claims to insurance companies.

The guy I was talking to was a tow truck operator and he was concerned that the mayor of my city had police call only her uncle’s tow truck company to accident scenes. This guy wanted in on the action because, “Insurance pays for the tow so we can charge more.”

Posted by: Weary Willie at February 19, 2017 6:03 AM
Comment #413460

Not only do we have insurance paying the fees and charges the medical industry set we also have the government paying those charges. The person paying the insurance premiums have no influence. They’re just happy they don’t have to pay the 23$ for a plastic tube or the 350$ for an x-ray or the 2500$ for an MRI.

Posted by: Weary Willie at February 19, 2017 6:08 AM
Comment #413476

“That is why you take the time and come up with a good bill..”

Jeeez, Willie, Republicans have had six years to come up with a good alternative to Obamacare. How long do you think this will take? Kind of strange since Republicans have been claiming that they had a great replacement years ago. Just teasing us, I guess.

As for insurance reimbursement rates, the only insurance payer that is effective in controlling medical reimbursement charges is Medicare. That is because Medicare doesn’t negotiate reimbursement rates, it sets them. According to a recent study, Medicare reimbursement rates are substantially lower than private insurance. Since 1999, it has consistently been about 80% of private insurance reimbursement rates. http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

Posted by: Rich at February 19, 2017 9:29 PM
Comment #413477

“That is why you take the time and come up with a good bill..”

Jeeez, Willie, Republicans have had six years to come up with a good alternative to Obamacare. How long do you think this will take? Kind of strange since Republicans have been claiming that they had a great replacement years ago. Just teasing us, I guess.

As for insurance reimbursement rates, the only insurance payer that is effective in controlling medical reimbursement charges is Medicare. That is because Medicare doesn’t negotiate reimbursement rates, it sets them. According to a recent study, Medicare reimbursement rates are substantially lower than private insurance. Since 1999, it has consistently been about 80% of private insurance reimbursement rates. http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

Posted by: Rich at February 19, 2017 9:30 PM
Comment #413479

I’m not sure where your link’s author came up with the figures they’re showing you. It said lower back disk surgery paid the doctor 1200$. I know for a fact lower disk surgery costs up to 280,000 dollars. I have a hard time believing the information in your link is relevant.

Posted by: Weary Willie at February 19, 2017 10:27 PM
Comment #413490

Rich and J2,

For the past 8 years we have witnessed ideological purity from both sides of the aisle.
The left wants/needs government controlled single-payer and the right isn’t big on massive government control and individual mandates.
As long as the left demands government be the solution and the right supports choice and the free market, not much will get done.

The left wants to just force it upon the American people and as we have seen with the ACA, that doesn’t work. Add that to the fact that premiums and co-pays went crazy, and quality of service was affected, and you get very unsatisfied voters.

A good bill would be thoughtfully worked out and implemented to help the people, rather than force an agenda. A successful bill would slowly transition from wanting choice to accepting single-payer, willingly.

Attacking those who disagree with you, insulting their intelligence, stupid rhetoric about racism and brainwashing, NONE of that has been working for the left.
Perhaps it’s time they try listening.

Posted by: kctim at February 20, 2017 10:04 AM
Comment #413491

Weary,

Can you answer the simple question as to why, after six years of claiming that they had a much better alternative to the ACA, Republicans have failed to reveal the plan or structure it in a bill before Congress?

Posted by: Rich at February 20, 2017 10:09 AM
Comment #413508

Rich asks why no Republican plans to replace Obamacare in past six year.

Sorry you missed it Rich. Easy to find with a Google search.

“There are at least seven different replacement plans that Republican legislators and conservative think tanks have offered in recent years.

http://www.vox.com/2016/11/17/13626438/obamacare-replacement-plans-comparison

Posted by: Royal Flush at February 20, 2017 5:13 PM
Comment #413509

Rich, IF you are asking ME, I already answered that earlier: Democrats will only accept a government plan. Anything less would have been DOA.

As Royal says, a simple search and you would find that they have come up with many plans.

Posted by: kctim at February 20, 2017 5:47 PM
Comment #413514

Well, if they have so many plans, why don’t they put together a bill. Should be simple. They have had many years to work it out. Maybe next year.

Posted by: Rich at February 20, 2017 7:39 PM
Comment #413515

“Well, if they have so many plans, why don’t they put together a bill.”

Whoa big fella. Before going on please tell us that you were wrong in stating that Republicans had no plans for replacing Obamacare in the past six years.

Leapfrogging to avoid consequences of either ignorance or false statements will not be ignored.

Posted by: Royal Flush at February 20, 2017 7:52 PM
Comment #413518

Royal,

Republicans never produced any serious alternatives to Obamacare. That failure is self evident from their inability to put forth such a plan today when they have control of both branches.

Posted by: Rich at February 20, 2017 8:34 PM
Comment #413532

“Republicans never produced any serious alternatives to Obamacare.”

Actually, as has already been shown, they have. As they don’t strictly conform to irrational liberal ideology, the left refuses to even consider them.

And after this whole “Obamacare” debacle, you guys have no room to talk about producing something “serious.”

Posted by: kctim at February 21, 2017 8:54 AM
Comment #413536

It’s funny how Rich insists;

Republicans have failed to reveal the plan or structure it in a bill before Congress?

and then when pressed;
Republicans never produced any serious alternatives to Obamacare.

How are we supposed to take you seriously if you have to backslide to make your argument? I remember a number of bills being passed by the house and blocked by the lying traitor, Harry Reid. Even if they did get past the Senate, Obama wouldn’t have given in to any type of concession to something the Republicans had any part of. Your claims of inaction by the Republicans on this issue ring hollow.

The last thing the Democratics need is a working government. Their influence would be gone if the Republicans came up with something we could accept. That’s why the Democratics are the obstructionist party. They have nothing but roadblocks to offer.

Rich, you’d better serve your party if you quit blindly following it’s leaders into obscurity. I hope you stick to the same tact you’re following now, because I want to see the Democratic party occupy a space in the garbage can of history. I want to see it at the bottom of that same cliff you pushed Grandma in her wheelchair off of.

I wonder how many children saw that ad. I wonder how many little minds were seriously affected by seeing someone push a defenseless Grandmother, in a wheelchair, off a cliff. And you guys criticize me for the thought of having your party join her. Hypocrites, all.


Posted by: Weary Willie at February 21, 2017 9:37 AM
Comment #413538

Willie,

The best thing that the Democrats can do politically is to keep “repeal and replace” of Obamacare front and center. It reveals that the emperor has no clothes. Republicans have cynically exploited Obamacare for six years. Time for them to be forced to put up or shut up. I think that they are attempting to quietly chose the latter.

Posted by: Rich at February 21, 2017 10:34 AM
Comment #413539

The current failures in the ACA were a design feature not a flaw. A single payer system was not in the cards previously; however, once you provide “free” insurance by putting people on Medicaid and subsidizing others, it is very difficult to go back. This was recognized at the time.

A more honest debate/choice would have been whether medical care is a “right”, to be paid for by the government.

Posted by: Mike in Tampa at February 21, 2017 12:04 PM
Comment #413542

Rich keeps entertaining us with his opinion while ignoring our facts.

I have posted links to insurance companies getting out of the Obamacare business due to huge losses. Millions of Americans have expressed their dissatisfaction with increased premiums, deductibles, copays, and reduced coverage. Even Democrat leaders have told us that Obamacare is in danger of total collapse.

I have posted links for Rich to read and learn about plans Republicans are looking at to replace Obamacare. I have posted links to articles describing some of the hurdles Republicans must overcome to treat the individual states fairly with their new plan.

After all that, the best answer our little Libbie Pal can respond with is…”It reveals that the emperor has no clothes.” Obviously debate is not Rich’s long suit.

Posted by: Royal Flush at February 21, 2017 2:54 PM
Comment #413556

Democratics have proven they can talk with their fingers in their ears. They refuse to even acknowledge the many votes on the ACA that were stopped by Dirty Harry The Lying Traitor. Their tactic is to ignore the obvious.

The wife walks in on the husband and his mistress. The mistress and the hubby starts dressing while the wife asks, “Who is this!?”. They keep ignoring her until the mistress is dressed and left. Only then does the husband address the wife. “Who is Who?”, he responds.

Posted by: Weary Willie at February 21, 2017 6:39 PM
Comment #413562

Mike in Tampa,

A more honest debate/choice would have been whether medical care is a “right”, to be paid for by the government.

That train already left that station 30 years ago when EMTALA became law.

Posted by: Warren Porter at February 21, 2017 11:48 PM
Comment #413563

That’s not a right, it’s a law.

Posted by: Weary Willie at February 22, 2017 12:55 AM
Comment #413591

Weary,

Yes, it’s a law that has the effect of a government guarantee of health to everyone regardless of ability to pay.

Posted by: Rich at February 22, 2017 4:56 PM
Comment #413599

Yes, I know. But, it’s not a right.

It’s also not a “guarantee of health”. Nothing can guarantee health.

Posted by: Weary Willie at February 22, 2017 5:52 PM
Comment #413613

The Republicans never had a plan, they had a repeal. If they had simply wanted to promote an alternative, they could have. But they can’t. Why? Because rhetoric drove their policy. Nothing more was really needed, as long as it was just red meat for the base. Now, though, they need a law that doesn’t lay waste to the insurance industry or the healthcare system, which doesn’t prompt a massive backlash in return.

If they had it, they would have pushed it forward. But the Republicans under Obama thought always put off that question.

Why?

Because Obamacare was Romneycare, and Romneycare was Heritage and Gingrich CongressCare. Penalize the free riders, provide subsidies to make sure insurance was bought, regulate the insurance system so they could no longer refuse people. Keep everything in private hands.

They don’t have an alternative! They torched their own plan to provide the fire for the Tea Party movement! Now, ironically faced with a successful expansion of coverage to millions of Americans through THEIR plan, they got to appear to do something to improve on Obamacare, or else face the firing squad they themselves invited.

The very delicacy of the necessary response tells you the trouble they’re in. They promised they’d do better. At the same time, they defined better as completely different from Obamacare. Only Obamacare was actually somewhat sensibly designed, offering protections people have come to value, protections they’ll miss. protections that may mean the difference between life and death for many.

On one hand, the Republicans need to satisfy the well-programmed voters who bought into their BS, clear the deck of Obamacare. On the other hand, their poorly informed voters might actually be attached to some of the policies that they never thought of as being part of Obamacare. They might be relying on the Medicaid expansion or the lifetime cap and preexisting condition ban. Even people who aren’t that politically astute might begin to realize that it was all this massive, massive con, that Republicans were just simply being oppositional for the sake of defeating Obama.

The Republicans have, in the process of creating red-hot opposition to the Democrats, also painted themselves into a corner, and potentially created a critical mass of disillusionment. Sooner or later, the truth will percolate through, and folks will realized that somebody lied to their face to get their vote.

Posted by: Stephen Daugherty at February 22, 2017 7:05 PM
Comment #413629

They know who lied, Stephen Daugherty. The Democratics proved they lied. Are you even going to give Republicans a chance to prove they lie the way America gave the Democratics the chance to prove they lied?

I really didn’t realize what a shambles the health care system in this country was before the ACA came in and “rescued” it. I paid just $600 for a doctor and a delivery room for the birth of my son. The hospital took payments until it was paid off. Only $600! What is it now? And why? Babies have been known to come out on their own at times without costing a dime!

Democratics keep wailing about our healthcare returning to what it was before the ACA was passed. They lament the idea of returning to a system in shambles, people dying in the streets, a system where a majority were left to die outside the emergency room doors. I don’t remember anything of the sort happening before the ACA came to be, but if a Democratic says it, it must be true, right Stephen Daugherty?

Now, Stephen Daugherty tells us, much to our surprise, it was Republicans lying to us. Geesh, I just don’t know what or who to believe anymore.

And they wonder why no one trusts the MSM these days.

Posted by: Weary Willie at February 23, 2017 9:44 AM
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