In their rush to dismantle the Affordable Care Act, congressional Republicans are engaging in a sleight-of-hand at the expense of people who are among the least able to fend for themselves, the severely mentally ill.
A mere four months ago, in December, Republicans were patting themselves on the back for approving what they called major mental health care legislation, the 21st Century Cures Act, a measure to increase funding for mental health care and ensure more treatment for severely mentally ill people.
“This is a new era of health care, and the next generation of hope for Americans that really transcends boundaries,” Rep. Tim Murphy, a Pennsylvania Republican who helped write the bill, said at the time. Advocacy groups were heartened.
But with the bait set comes the switch. The American Health Care Act, the slick handiwork of House Speaker Paul Ryan, Majority Leader Kevin McCarthy and other congressional Republicans, would eliminate much of the Medicaid coverage guaranteed under the Obama administration’s Affordable Care Act for mental health care and addiction services.
Treatment Advocacy Center, a proponent of the 2016 legislation and a leading advocate of providing care for severely mentally ill people, warns that provisions in the new Republican bill “limiting or eliminating mental health as an essential health benefit will only serve to raise costs, as individuals without access to mental health care deteriorate and become sicker.”
“Experience shows us that without access to appropriate care, these individuals often end up receiving more expensive and less therapeutic care – provided by crisis centers, emergency rooms, homeless shelters and jails,” the organization noted.
Although the exact number of people who would be affected by the Ryan-McCarthy bill’s passage is not yet clear, various reports estimate that 1.3 million mentally ill and drug-addicted people covered by the Medicaid expansion that was part of Obamacare will lose care by 2020. It could be many more.
Cutting coverage that helps keep these individuals stable would be nothing short of cruel, but it is sadly understandable. These people don’t give campaign donations and few of them vote. They are in and out of institutions and housing. Always teetering, they have no clout.
Congressional Republicans ought to heed their better angels. Understanding that we are judged by how we treat the least among us, many red-state governors accepted billions of dollars collectively from the Obama administration and provided help to people living on the fringes.
Beyond the Beltway, where partisan wars don’t rage quite so heatedly, some leaders don’t want to go back. One is Gov. John Kasich of Ohio. People who watched Republican presidential debates last year may recall Kasich as the one top-tier candidate who took time on the national stage to talk about the need to care for those with severe mental illness.
Kasich, nobody’s liberal, criticized the Republican plan last week: “Phasing out Medicaid coverage without a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug addicted, mentally ill, and working poor who now have access to a stable source of care.”
Officials who oversee Covered California, this state’s version of Obamacare, and Medi-Cal, our version of Medicaid, are in the process of analyzing the implications of the Republican legislation. Although that analysis is not complete, the impact clearly will be significant.
“There is nothing in here that makes it better for us,” California Health and Human Services Secretary Diana Dooley told an editorial board member.
No state has been more aggressive in implementing Obamacare. California added more than 5 million people to insurance rolls, including 4 million who are covered by the federally funded Medi-Cal expansion.
The Republican plan would slash Medicaid payments to the states. For California, that could be $7 billion by 2020. No governor or Legislature could cover that without a huge tax hike or steep cuts to schools and other state-funded programs. Gerald Kominski, director of the UCLA Center for Health Policy Research, believes 1 million to 3 million newly insured Californians face loss of coverage.
They are people like the 37-year-old man who lives in the Land Park garage of his 68-year-old mother, Bonnie; she asked that she not be further identified to protect his privacy. A retired state worker, Bonnie cannot afford to buy her son a health insurance policy, but she did help him fill out the application so he could get Medi-Cal coverage.
He has coverage now and is taking anti-psychotic medication. He’s still reclusive and unable to work, but he no longer thinks Bonnie is trying to poison him when she makes his dinner.
“They are forgetting that we all have an obligation to one another. That is one of the things this country is built on – a mutual caring,” Bonnie said of congressional Republicans.
In 2016, Barack Obama asked voters to elect Hillary Clinton to continue his legacy. That included his signature domestic achievement, Obamacare, which Republicans now think they have a mandate to end.
But mental illness strikes the sons and daughters of Republicans, just as it does those of Democrats, and when vulnerable people break down, the attendant costs – financial, societal and moral – find their way to us all, no matter our party. Of all the ways in which Trumpcare puts ideology over need, this is perhaps the most sickeningly shortsighted. The care of the least among us should not be partisan.