While the AHCA would also establish a $15 billion fund for maternity care, mental health, and substance abuse treatment, an analysis from the Congressional Budget Office found that this fund wouldn’t offset the destabilizing effects of state waivers on mental-health coverage. “In particular,” states the report, “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services.”
Many people facing those massive spending increases or Medicaid coverage losses reached out to me via email to discuss just how the AHCA would impact them. One woman, who was insured through Kentucky’s adoption of the ACA’s Medicaid expansion, wrote:
I have a number of pre-existing conditions under the umbrella of mental illness or behavioral health: major depressive disorder, attention deficit hyperactivity disorder, and I am a recovering alcoholic. All of those are manageable with various daily maintenance, namely medication. I have been on the same medicines for 3 years and all are really helpful, especially the ADHD meds. Because I am in recovery, my psychiatrist and I decided I should try the only non-amphetamine med for ADHD: Strattera. It's amazing, except that it is $500+ without insurance ... If Medicaid expansion goes away, there is no way I can afford my medicine. Without medicine, though, I will definitely lose my jobs and serious risks associated with these conditions.
It's so frustrating: I am a hard-working person who has been sober for over 13 years. With no protections for pre-existing conditions or behavioral health, I'm left to consider working less to qualify for traditional Medicaid or trying to file for disability. But I can work and I want to work.
The AHCA’s disinvestment in mental-health and substance-abuse services would also have major effects on the places that tend to provide care. According to another reader:
Community mental health centers like the one I work at will be doubly penalized. The AHCA reduces Medicaid availability, leaving more of our clients without any medical insurance at all. So we will be serving fewer people with insurance that we can bill for services. Add to that the fact that for those clients we have who get to keep their coverage we will see reduced coverage/payments for those services. Since we can't turn anyone away for lack of ability to pay, this will gut our ability to provide core services for our clients.
Of course, these changes to mental-health and substance-abuse coverage and care don’t occur in a vacuum. The ongoing opioid crisis is the most pervasive, expensive, and deadly drug epidemic to ever hit the country, and the AHCA would unquestionably curtail federal tools for combatting it.
"We have statistics that say that Medicaid is paying for something like 35 percent to half of all medication-assisted opioid treatment,” says Walter. And the decreased funding for Medicaid would not only risk cutting in half federal funds for medication-assisted treatment, it would also decrease cost-effective preventative care that could identify and assist people before they start spiraling through addiction. As my colleague Olga Khazan reports, research indicates that at least some of the opioid crisis is created—and then exacerbated—by widespread mental-health issues like depression. So the AHCA would be something of a double whammy: diminishing both the prevention and the crisis-response functions of public health.