Community voice
Each day in the United States of America over 250 people die from drug overdoses and suicides. While the suicide rate in the country has climbed steadily during the first part of the 21st Century, the rate of drug overdoses has exploded at unprecedented levels during that same time period. The country is in the grips of an opioid epidemic that is devastating communities, shattering families, and overwhelming the capacity of local, state, and federal officials. The underlying medical conditions that directly lead to these deaths--mental illnesses and substance use disorders--are responsible for one of the most dire public health crises facing the nation today.
As the Affordable Care Act (ACA) awaits its fate before the Republican-controlled 115th Congress, it is important to note what the ACA has delivered for those affected by mental illness and addiction. The ACA and its implementing regulations requires all non-grandfathered individual and small-group (50 or fewer employees) health insurance plans to cover mental health and substance use disorder (behavioral health) treatment as part of the Essential Health Benefits package. In addition to the mandate that these insurance plans include behavioral health coverage, they must also comply with the Mental Health Parity and Addiction Equity Act (the Federal Parity Law), which was signed into law by President George W. Bush in 2008. The Federal Parity Law requires health insurance plans to cover behavioral health treatment in a way that is no more restrictive than how they cover other medical treatment. Previously, the Federal Parity Law only applied to large-group plans and Medicaid managed care plans. The ACA and the Federal Parity Law are critical for those with behavioral health conditions because prior to their enactment insurance plans either had very limited coverage for behavioral health treatment, or coverage was excluded entirely. Republicans in Congress and President Trump have maintained that a “repeal and replacement” of the ACA—or Obamacare, as they call it—is one of their top policy priorities. However, they have encountered resistance both from the public, and from members of their own party. As the party establishment, led by Speaker Paul Ryan (R-WI), huddles to craft legislation, other Republicans have already introduced legislation. The first bill introduced explicitly retains behavioral health coverage in the individual and small group market that meets the requirements of the Federal Parity Law. While that bill is not supported by the party at large, it is telling that the first ACA replacement bill identified behavioral health insurance coverage as something too important to eliminate. Maybe this should come as no surprise, though. Voters in many of the states and counties in the country most heavily affected by the opioid crisis gravitated to Donald Trump in the 2016 election. What this suggests is that Republicans need to consider all of the political ramifications of altering health insurance benefits for millions of Americans, especially those who live in states ravaged by overdoses and suicides. Democrats must also be aware of the potential political fallout that would occur if millions lost insurance coverage protections for behavioral health coverage. Why would Democrats have to worry? Aren’t they largely spectators in this process with no real power to stop it, you might ask? Actually, no. Thanks to something known as the Byrd Rule in the Senate, Republicans can’t simply repeal the entirety of the ACA through a budget reconciliation bill, which only requires 51 votes to pass. This is especially true for the health insurance market reforms—such as the mandate for behavioral health coverage—because they do not have a direct budgetary impact and therefore would likely be deemed “extraneous” and in violation of the Byrd Rule. What this means is that to eliminate the requirement that insurers cover behavioral health treatment, 60 votes are needed in the Senate, which means eight Democrats would have to go along. The most effective messaging points for anyone advocating that behavioral health treatment remains covered in the individual and small-group market are simple. They are three questions directed at Senators:
Those questions will not be easy to answer for any Senator who is thinking of voting Yea for a bill that will remove the landmark behavioral health insurance protections that were guaranteed to millions of Americans on March 23rd, 2010. Make sure that members of Congress understand that you expect them to answer those questions directly and truthfully. |
Who Can Contribute?Community Voice authorship is shared by diverse members of the Public Health and Philadelphia communities. Archives
March 2017
Categories |