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Defeating the legislative tsunami engulfing health reform

May 22, 2017
by Ron Manderscheid, PhD, Exec Dir, NACBHDD and NARMH
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I recall not a single time in my entire career when behavioral healthcare, and healthcare in general, have been under greater siege than at present. 

The current struggle, like a huge tsunami, is sweeping across everyone—children, adults, older Americans, persons with disabilities, family members, providers, counties and states, managed care companies, insurance entities, national healthcare organizations, and even the federal government. Everything in its path is threatened with destruction. As a result, people are uniting quickly in common cause to take urgent action to defeat the tsunami.

Just imagine what would happen to a friend with a serious mental illness, a serious substance use condition, or a serious developmental disorder if the House Republican American Health Care Act (AHCA) were to be enacted. Our friend no longer would have a right to health insurance; his or her insurance premiums would skyrocket, growing from $2,700 per year with premium subsidies to $13,500 without them. If our friend were so poor as to qualify for Medicaid, there is no assurance that the Essential Health Benefits actually would be available in the state plan. And if our friend were selected for the state’s high-risk pool, there is no assurance that adequate funds would be available to secure essential care. Clearly, I am painting a very draconian picture.

Yet, if our friend were young and healthy, his or her insurance premiums would be reduced dramatically. This really is, however, just another sleight of hand. Our young friend’s new insurance plan would offer far fewer benefits, and, if our young friend were to become ill or disabled, he or she would suffer the same fate as our other friend with a serious condition.

This very, very unfortunate reality is propelling an unprecedented, urgent and united adverse response to the AHCA. It just is beyond reason for Congress to pass a piece of legislation when just 21% of Americans approve of it, per a recent Quinnipiac University poll.

Similarly, in unprecedented unanimity, all major stakeholder groups in health and behavioral healthcare have united in opposition to the AHCA. Again, it is just beyond reason for Congress to pass a piece of legislation when the entire healthcare industry—20 percent of our Gross Domestic Product—opposes it.

The big picture of this tsunami shows vast potential devastation:

  • Elimination of health insurance for 24 million Americans
  • Elimination of $890 billion in Medicaid funds for states and counties
  • Elimination of premium and care subsidies for the near poor
  • Elimination of guaranteed insurance and equitable premiums for persons with disabilities.

And this list goes on, and on, and on…

I know that the vast majority of you do not have much experience in opposing federal legislation or in advocating for legislative changes. This must not deter you from action. Now is the time to step forward and show your mettle—show what you actually stand for. We must lock arms and march forward in unison.



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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