Many people are worried about what might happen to mental health care under a President Trump administration. People with serious mental illness like bipolar disorder, major depressive disorder and schizophrenia are some of the most vulnerable in society and some of the least able to afford expensive mental health care. They are also some of the most likely to be devastated by the repeal of the Affordable Care Act (ACA, Obamacare) and other health care policy changes the Trump Administration plans to make.
The Affordable Care Act Has Been Critical to Those with Mental Illness
The ACA was also instrumental in getting health care for those with mental illness as it made mental and substance abuse disorder services an “essential health benefit” and insurance companies couldn’t sell Obamacare without this one-of-10 essential service. The ACA ensured that psychiatric illnesses were treated the same as a non-psychiatric illnesses such as cancer.
Before the Affordable Care Act, health insurance providers often carved mental health care out of individual coverage treating it in a unique way. This left people with mental illnesses or substance abuse problems with unrealistic annual or lifetime limits on coverage or, indeed, no coverage at all. The lack of coverage was also, in large part, due to the fact that previously, those with serious mental illness were often excluded from coverage due to a “pre-existing condition.”
In an interview with me, Jessica Gimeno, Health Advocate and original member of the Healthcare Rights Coalition, who has multiple chronic conditions including bipolar disorder:
Finally, I was covered through Medicaid. Medicaid covered co-pays, the cost of medications, and medical procedures like surgery. It was a relief to have a great neurologist and primary care physician and know my family was not going to go bankrupt just to keep me alive.
Considering the opioid abuse epidemic and the fact that suicide rates are at an all-time high, mental health and substance abuse coverage is clearly needed.
Mental Health Professionals Beg President Trump Not to Gut Mental Health Care
In a letter to President Trump, the American Psychological Association and the American Psychological Association Practice Organization said that a repeal of the ACA that doesn’t include a replacement that protects Americans with mental illness puts millions of American lives in danger.
Health Care in Trump’s Administration
The problem, and why so many patients and doctors are worried, is because while President Trump ran on a platform of repealing the APA, there is no viable, detailed replacement currently on the table. And without another plan in place, people are scared they will be left in no-man’s land.
Tom Price, President Trump’s pick for Health Secretary, has said that insurers need only insure pre-existing conditions for individuals who have had coverage for the last year and a half. Those who do not meet this criteria could be charged up to 150 percent of the standard rate for two years. Additionally, Price may use high-risk pools to cover those with pre-existing conditions who can’t get insurance on the open market. One billion dollars of funding over three years may be used. This is far short of Paul Ryan’s plan which calls for $25 million over 10 years. The trouble with high-risk pools is that while the plans tend to be similar to individual insurance policies, they often have had waiting lists, higher premiums and large deductibles that people, like those with serious mental illness, can’t afford.
Additionally, CNN Money has noted that Price’s plan would “reduce assistance for many lower-income folks,” and, unfortunately, many people with serious mental illness fall into this category. The expansion of Medicaid under the ACA would, effectively, be rolled back and many people with serious or chronic illnesses, such as mental illnesses, will also lose their coverage that way.
What Will Happen with Trump’s Health Care Plans?
An example of the differences as given by CNN Money is:
Take a 27-year-old with an income of $25,000 a year. He can receive an average of $1,920 in subsidies to pay for the benchmark Obamacare plan, which will cost an average of $3,624 in 2017, according to federal data. But under Price’s plan, he’d only receive $1,200 to offset the price.
Under Trump and Price’s health care plan, those with serious mental illness who cannot get insurance might have to go back to using emergency rooms for care. This causes a stratospheric rise in health care costs for hospitals. And one psychiatrist even predicts a higher number of deaths by suicide.
Gimeno has this to say about health care in Trump’s America:
This is the beginning of the GOP cutting the social safety net. It will be terrible for people with disabilities, the elderly, and the poorest. All GOP alternatives on the table from Paul Ryan and Tom Price involve a return to high-risk pools, Medicaid block grants or per capita grants. These are all bad for the most vulnerable members of society. I would lose my Medicaid if the ACA is repealed; it would be like going back to the healthcare Stone Age. What kind of society do we want to be?
NYTimes.com, The Mental Health Crisis in Trump’s America.
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