Shocking! So shocking to me!
And I bet you were just as shocked when the Avalere estimates for the Graham-Cassidy health reform bill were released on Wednesday. The Avalere estimate: Graham-Cassidy would take $4.2 trillion out of health by 2036. In comparison, the $1.5 trillion that would have been removed by the Republican leadership through the proposed American Health Care Act or its ill-fated replacement, the Better Care Reconciliation Act, is just a dwarf amount. Just two months ago, we actually thought that removing $1.5 trillion was outrageous!
And the impact on some of the states would be equally shocking. Between 2020 and 2036, virtually all states would experience dramatic federal funding reductions due the progressive negative impact of the Medicaid per capita caps starting in 2020 and the end of the ACA block grants in 2026. The reductions would total $78 billion in Colorado, $120 billion in Texas, $161 billion in Ohio, $199 billion in Florida, $436 billion in New York, and $800 billion in California. Just imagine: $800 billion in California alone! I do not need to tell you that reductions of this magnitude would be completely and absolutely devastating for our efforts in behavioral health.
Even with today’s funding, we already struggle and are unable to reach the majority of persons with behavioral health and ID/DD conditions who are homeless or incarcerated, or the majority of children who are developing these conditions. Already, in many places, we experience the initial symptoms of the collapse of our local communities—the basic fabric that allows us to have a functioning social life. Many people are subjected to danger, risky environments, and progressive despair. By removing the key health and social supports that currently maintain our social fabric, we may very well experience complete collapse in some communities. This would be tragic for all of us.
At the same time, imagine the profound chaos that would be created in all states as each attempts to respond to the demands of the Graham-Cassidy bill and recreate the ACA or devise its own state replacement for a national healthcare system. We all know that many states simply are not up to this task.
So, I must ask: Do we want to witness the failure of behavioral healthcare? Do we want to see the collapse of our local communities? Do we want to see the states fail to deliver any health care? Clearly, our answer must be, “Absolutely not!” And even stronger, “Resolutely…not on our watch!”
We can and must change these unacceptable eventualities. The US Senate can vote down the Graham-Cassidy bill next Wednesday. This will not happen, however, if we do not apply exceptional pressure on each of our 100 senators. Unfortunately, the U.S. Senate has gone completely off the rails. Logical, rational arguments no longer govern the day in the U.S. Senate. Instead, Senate actions are based upon complete fabrications and half-truths, large financial payoffs for votes of other senators, and deep, endless political calculation. As one White House official said: "We really aren't sure what the impact will be" of passing this bill.