As Democrats and outgoing federal health officials consider the future under the Trump administration, they aren’t mincing words about Republicans’ vow to repeal the Affordable Care Act (ACA). For example, Sylvia Burwell, secretary of the Department of Health and Human Services (HHS), warned of “chaos” for the 20 million people who are now enrolled in ACA plans if the law is repealed.
The big question remains whether Republican lawmakers will acquiesce to the idea of crafting an ACA replacement in advance of a repeal.
County behavioral health service providers are especially concerned about what the near future might bring without a practical transition plan. Jeannie Edens, associate director of behavioral health services for Salt Lake County, says in Utah, behavioral health safety net services for the uninsured or underinsured fall to counties, where the wait lists can be as long as eight months.
“If we think it is difficult now to keep our heads above water, I hate to imagine what it will be like in the future should Congress repeal without replacing the ACA, or replace it with a lesser option,” Edens says.
She has a checklist of vital elements that must be addressed within an ACA transition strategy, such as keeping behavioral health coverage as an essential benefit and prohibiting insurers from denying coverage for pre-existing behavioral health conditions. Otherwise, the ripple effects will be costly.
“Should our residents lose this coverage, county wait lists will increase, some will lose their jobs and housing as their conditions worsen, eventually costing the taxpayer more as those struggling most land in our hospitals, jails and prisons,” Edens says.
Keeping ACA perks
While the president-elect has expressed interest in keeping some popular ACA elements, an offset would be needed to make such a plan financially viable. For example, the pre-existing condition provision and the rule that allows children to stay on their parents’ plans until age 26 currently are offset by the individual mandate that requires everyone to sign up for health coverage. The individual mandate drives a larger pool of enrollees, which allows for the richer coverage. Without that economic balance, history has proven that insurance plans simply become unaffordable and collapse.
Even though Utah never opted into Medicaid expansion, Edens says ACA has offered an unprecedented opportunity to help individuals with mental health and substance use disorders. The state has one of the highest rates of suicide and ranks fourth in the nation for drug overdose deaths.
“There is a great deal of stigma attached to mental illness and addiction,” she says. “Thanks to the ACA, we are making strides to lower that stigma and engage folks into the care that they need, recognizing these are health conditions not moral choices, and treating them as such.”