GOP Threat to Mental Health Treatment

Leading health care stakeholders are condemning the Republican health care plan, with some expressing grave concerns about its impact on mental health treatment. The National Alliance on Mental Health (NAMI) says the Republican plan puts “millions of Americans with mental illness at risk.”


Many major organizations immediately rejected the health care plan proposed this week by Republicans in the U.S. House of Representatives to replace the Patient Protection and Affordable Care Act, also known as Obamacare. Among them: the American Medical Association, the American Nurses Association, the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association of the United States, and the Children’s Hospital Association. The AARP, which represents 38 million older Americans, said: “This bill is a $200 billion giveaway to special interests like insurance and drug companies. They make out like bandits while real people are left with higher premiums and less security.”

In a letter to House Republican leaders, AMA CEO James L. Madara criticized the “potentially life altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated.” Madara warned that changes to Medicaid could undercut state efforts to cope with increased demand for mental health and substance abuse treatment as a result of the ongoing crisis of opioid abuse and addiction. (An estimated 1.3 million Americans receive treatment for mental health and substance abuse disorders covered by Medicaid’s expansion under Obamacare.)

ANA President Pamela F. Cipriano also complained that the Republican plan would eliminate the Prevention and Public Health Fund and cut off critical coverage for millions of Americans with mental health and substance-use disorders.

Here’s NAMI’s statement about the Republican plan’s threat to mental health treatment:

The American Health Care Act (AHCA) would reduce funding for health coverage—from insurance plans to Medicaid—and put mental health care at risk. It caps Medicaid funding, which will lead to deep cuts and jeopardize mental health services.

Congress shouldn’t put millions of Americans with mental illness at risk. Cutting corners in health coverage will keep people from getting the treatment they need and will push people with mental illness into costly emergency rooms, hospitals and jails.

Investing early in affordable, quality mental health care promotes recovery and saves taxpayer dollars in the long term by avoiding disability, criminal justice involvement and frequent hospital stays.

Here are the provisions NAMI says will harm people with mental illness:

Individual and Small Group Health Insurance

Current federal help to buy health insurance would be reduced, leaving millions of people, including people with mental illness, unable to afford mental health care.

Traditional Medicaid

Traditional Medicaid would be converted to a “per capita cap” system, which means states would get a fixed amount of federal funding per person. Instead of flexibility, this would lead to deep cuts over time and jeopardize mental health services.

Federal Medicaid funding would be frozen at current levels, adjusted for inflation. Funding for mental health and substance use services is already inadequate and could not be improved without cutting other needed health care.

Medicaid Expansion

Nearly 1 out of 3 people covered by Medicaid expansion live with a mental health or substance use condition. This bill would end new enrollment in 2020, leaving people with mental health and substance use conditions without the Medicaid services they need to stay in school, on the job and in recovery.

Medicaid expansion plans would no longer have to cover mental health and substance use care, abandoning Congress’ commitment to mental health and substance use coverage.

People covered by Medicaid expansion before 2020 would be dropped from their plan if they have a lapse of coverage of more than a month. For people with mental illness, this is a high price to pay for forgetting to pay a premium while someone is in the hospital or experiencing severe symptoms.

NAMI says that one in five Americans experiences a mental health condition, but only half get needed treatment. It argues that coverage for mental health care helps people get treatment when they need it, helping them to stay in school, on the job and in recovery.