GOP Plan Strips Addiction, Mental Health Coverage For Millions As Opioid Deaths Soar

As U.S. communities and medical infrastructure scramble to care for the record number of Americans suffering from substance abuse and mental illness, residents and experts worry the GOP's proposed American Health Care Act could cut off addiction and mental health support for millions who need it most.

As the Washington Post reports, the frankly named AHCA stands to recall "essential coverage for drug addiction treatment [and] mental health," and create an unequal burden on states already beleaguered by the nation's opioid crisis. If passed, the plan would eliminate an Affordable Care Act (ACA, or "Obamacare") mandate that Medicaid cover basic mental health and addiction services and roll back the ACA's Medicaid expansion in West Virginia, Ohio and 28 other states starting in 2020.

According to the Post, House Republicans confirmed those intentions Wednesday to the House Energy and Commerce Committee, arguing that dropping the mandate would give states flexibility while allowing them to still provide support with Medicaid dollars if they want to. A lawyer for Republicans on the committee noted, "The text before us does remove the application of the essential health benefits for the alternative benefit plans in Medicaid, [including mental health]."

However, critics worry that losing the essential health mandate for addiction and mental health treatment could see patients facing much higher prices for care. Joshua Sharfstein, associate dean at Johns Hopkins Medical School, told the Post, “Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic.”

As Vox explains, numerous experts anticipate the plan will "allow insurers to effectively cut coverage for addiction care," which the ACA expanded to include 2.8 million Americans with such disorders. Come 2020, the site says, the bill would end mandated "actuarial value" for insurance plans, which ensures a certain percentage of health costs gets covered by insurers. Without a mandated actuarial value on mental health and addiction services deemed to be "essential," insurers could then charge patients a great portion, or higher prices, for their treatment.

Richard Frank, a Harvard health economist, told Vox, “You need all of those pieces together ... You want to say these are the buckets that have to be part of an insurance plan, and then within that you need to offer coverage that protects people in certain ways — and that’s what the actuarial value does.”

Of course, it's difficult to estimate the overall and long-term costs of rolling back managed, insured care for addicts and sufferers of mental illness, either for patients or society as a whole. Nevertheless, research suggests that the impacted group would be a large one, spanning all income and/or AHCA brackets.


Mark Lewis, holds a photograph of his 27-year-old son who died from a heroin overdose, during a Utah Department of Health press conference

According to the National Alliance on Mental Illness (NAMI) approximately 1 in 5 adults in the U.S., or 43.8 million, experiences mental illness in a given year, and 1 in 25 adults, or 9.8 million, experience "a serious mental [that] substantially interferes with or limits one or more major life activities," as do a substantial percentage of kids. As of 2006, 36.2 million Americans also shelled big out for mental health services, totaling $57.5 billion or an average of $1,591 per person. Those 4.6 million children able to access and afford mental health services averaged $1,931 each, which hardly seems fair (or efficient).

Individual costs have since come down, but officials still consider mental illness one of the nation's most expensive, especially when it has gone untreated. According to the National Institute on Drug Abuse, meanwhile, the overall costs to the U.S. of crime, lost work productivity, and health care related to alcohol and illicit drugs are $224 billion and $193 billion a year, respectively.

https://www.forbes.com/sites/janetwburns/2017/03/10/gop-plan-strips-addiction-mental-health-coverage-for-millions-as-deaths-and-costs-soar/#4a4f04d5a3e4