The AHCA Could Destroy American Mental Health Care

by s.e. smith
Chip Somodevilla/Getty Images News/Getty Images

Today, the House GOP passed the American Health Care Act — a "health reform" bill that, according to reports, many Republican representatives didn't even like (see how your representatives voted here), but which they're convinced is the first step in repealing the Affordable Care Act. The bill contains a series of shocking provisions that would roll back key gains, particularly surrounding anti-discrimination protections for people with preexisting conditions and core coverage requirements for insurance, and it would cause premiums to skyrocket. Disabled people, trans people, women, seniors, and low-income Americans have the most to lose from this bill, while the wealthy and insurance companies will be profiting.

One serious consequence of the bill will be a major setback for mental health parity, an issue the disability rights movement has been fighting on for a very long time. It's also an issue that's personal for me, because I'm mentally ill, and parity extended through the ACA and Obama-era regulatory processes has had a profound effect on my quality of life.

In the insurance industry, a peculiar and artificial divide has risen between mental and physical health. Historically, insurers could refuse to extend coverage for mental health services, or could put severe limitations on coverage, such as restricting the number of therapy sessions covered each year. Unsurprisingly, many mental health professionals, even now, don't accept insurance, because it's not worth the fight.

It's inhumane and bizarre to act like mental health isn't part of overall holistic health — someone with untreated or poorly treated mental illness is going to struggle to function. That's also going to spill over into their physical health, creating a cascade of problems. That's one reason the Affordable Care Act included treatment for mental health and substance abuse conditions as part of its Essential Health Benefits, declaring it was something all insurers should cover.

For those of us who have spent our entire adult lives fighting disparities and injustices in the health care system in America, the sudden national interest is heartening, but also worrying. Please don't walk away now. Please stay with us.

This dramatically increased access not just to insurance, but specifically to mental health treatment, for millions of Americans, especially those who accessed insurance through the Medicaid expansion, explains the National Alliance on Mental Illness.

Suddenly, our insurance actually had to pay for the treatments we needed to survive. That meant therapy, medications, and anything else that would help us manage mental health conditions more effectively, including proactive preventative care that kept us out of the hospital.

In addition, parity made it easier for people in distress to seek treatment, because they knew they could access care — and preexisting conditions provisions meant that having a mental health diagnosis in your chart wouldn't adversely affect future eligibility for coverage. Similarly, premiums wouldn't jump for mentally ill people, thanks to the ratings rules that limited the situations in which insurers could adjust premiums.

Overall, the ACA isn't perfect, but it did make it much, much easier for the approximately 20 percent of the population that experiences mental health issues annually, according to the National Alliance on Mental Illness, to get care. That made it easier to focus on doing what we love, and contributing to society. It kept us safer, and for all you utilitarians out there, it also saved a ton of money.

By covering the pretty nominal costs of therapy and medication, insurers got to skip things like costly hospitalizations and prolonged inpatient treatment for people who went into crisis. Fewer people in mental health crisis also reduced strain on community and emergency services, like the police officers who are sometimes called when someone's in mental health crisis because there's no other option.

Net good for mentally ill people, and net good for society. Everyone wins, right?

One of the frustrating and paradoxical things about watching Republicans attempt to systematically destroy the Affordable Care Act is the growing realization that the party isn't acting out of practicality, a desire for efficiency, or even fiscal conservatism. This is about revenge, and it will come at a tremendous cost for millions of Americans — though the Congressional Budget Office didn't have time to score the latest iteration of the bill before the GOP rammed it through, their estimate on the prior version had 24 million people losing insurance by 2026.

Now, thanks to the waiver program that will allow states to strike key ACA provisions, things like the precious essential health benefits are in question.

Mental illness is still something that lives very much in the shadows of the United States, shrouded in stigma, hatred, and distrust. The ACA made it possible to fight back, and this will erase those gains — and in some cases, make them worse, as people with shiny new diagnoses on their charts could experience premium increases over $8,000 if they have bipolar disorder or other severe mental illnesses, according to the Center for American Progress. These cost increases will be compounded by changes in what is covered, and the patient's expected share of cost.

For those who have treatment-resistant mental illness, the fragile dance of constant psychiatry appointments, tapering on and off various drugs, trying things like transcranial magnetic stimulation, and fighting to get into clinical trials will get harder. More and more will fall through the cracks. Mental illness is a common factor in chronic homelessness and unemployment; the party that likes to screech about "drains on the system" is condemning people who can lead full, active, happy lives to struggling in the gutter.

I hope Republican lawmakers who just told me and many people I love that we should essentially go die in a corner are happy. But I also hope that those who came out of the woodwork to mobilize when they thought their health insurance was threatened are ready to stay the course and keep fighting, because this is not over.

For those of us who have spent our entire adult lives fighting disparities and injustices in the health care system in America, the sudden national interest is heartening, but also worrying. Please don't walk away now. Please stay with us. Please seek out information on the diverse groups affected by legislation like this, and related rulemaking, because this is much, much bigger than you realize.

This bill aims to destabilize nearly a decade of gains for Americans who are forced to rely on health insurance to pay for their care, since the U.S. resolutely refuses to pass universal single payer health care. The AHCA is far from a sealed deal, given that it has to pass the Senate and the current form isn't very popular there, as NPR explains — but this vote was a clear illustration that Republicans don't care about the long term health of the nation. That includes that of mentally ill people who rely on continuous, ongoing care to stay healthy, happy, and alive.