BEYOND THE NUMBERS
We explained earlier today why a Republican leadership plan to add $15 billion for behavioral health treatment and maternity coverage and newborn care to the House health bill would do little to offset the enormous damage that the underlying bill would do to millions who would lose these important categories of care.
Here, more specifically, are four ways that the House bill would harm people with mental health and substance use disorders:
Effectively ending the Medicaid expansion. Starting in 2020, states would receive only their regular matching rate of federal funds, rather than the Affordable Care Act’s (ACA) enhanced 90 percent rate, for people newly enrolling in coverage under the ACA’s Medicaid expansion. Most states would likely respond by freezing enrollment in their Medicaid expansion, because they’d otherwise have to pay 2.8 to 5 times more to cover people starting in 2020. The Medicaid expansion would then disappear — the Congressional Budget Office (CBO) estimates that two-thirds of those enrolled as of the end of 2019 would fall off the program within two years and fewer than 5 percent would remain covered by the end of 2024.
The Medicaid expansion has greatly benefited people with substance use disorders. For example, in expansion states the share of people with substance use or mental health disorders who were hospitalized but uninsured fell from about 20 percent in 2013 to 5 percent by mid-2015. Ending the expansion would jeopardize access to behavioral health treatment in many of the communities hit hardest by the opioid epidemic.
Slashing federal Medicaid funding. The House bill would radically restructure Medicaid by converting it to a per capita or block grant starting in 2020. Both options would give states considerably less federal funding than under current law, with the cuts growing every year. To compensate, states would have little choice but to cut eligibility, payments to hospitals and doctors, and benefits — including behavioral health services. Cutting federal funds would also stymie state innovation that requires up-front investments, such as better integrating physical and behavioral health services.
The block grant option would also give states virtually unfettered authority to decide how to spend their federal funds. That would further jeopardize beneficiaries’ access to care. For example, children could lose Medicaid’s comprehensive pediatric benefit known as EPSDT (Early and Periodic Screening, Diagnostic and Treatment), which ensures that they have access to needed behavioral health services.
- Eliminating the ACA’s essential health benefits requirement in Medicaid. The ACA requires most individual-market health plans to cover ten essential health benefits (EHB), including mental health and substance use treatment. It also requires states to provide these benefits for Medicaid expansion enrollees. The original House bill eliminated this requirement for plans sold in the individual market; the updated bill would also eliminate it in Medicaid, so beneficiaries enrolled in managed care plans would likely see cuts in behavioral health services.
- Imposing harsh work requirements on unemployed adults with behavioral health needs. The updated bill would allow states to require all adults who are not seniors or people with disabilities to work or search for work in order to maintain their Medicaid eligibility. That would particularly harm people with opioid or other substance use disorders who can’t work now. They would be cut off from coverage, including the treatment they need to regain their health and rejoin the workforce.
As Rep. Joe Kennedy explained during the House Energy and Commerce Committee’s consideration of the GOP bill, the bill could put mental health and opioid addiction treatment out of reach for many people who are in the fight of their lives. The last-minute addition of one-time funding doesn’t change that.