Looking Beyond the Better Care Reconciliation Act
My daughter is now on medication for her bipolar disorder. The change in her is like night and day, and it’s been nothing short of a miracle. In just a few weeks since beginning her medication, she is noticeably calmer, more steady, more sure of herself. I can hear it in her voice — the scattered, frenetic edge in her conversations is no longer there. She is learning to put life’s challenges in perspective. Life’s little bumps aren’t cause for 3 a.m. calls anymore.
Thankfully, she is more than willing to take medication on a regular basis, possibly for the rest of her life. During a casual conversation about her medication one night, she told me that the medication would cost $1000 without insurance.
“That’s crazy,” I said. “How do people with bipolar pay for their medication if they don’t have insurance?”
“They don’t get on medication,” she said flatly. That means they remain mentally ill without treatment, which only makes their condition worse.
And once again, mental health and treatment become a privilege for those who have resources and for those who are lucky. Unfortunately, many people who suffer from mental illness don’t have either one of those things.
Which brings me to discuss the recently defunct Better Care Reconciliation Act (BCRA), the Senate healthcare bill that met an abrupt and untimely end last week.
As a quick refresher, the BCRA came under fire from parties on both sides of the aisle because it contained major cuts to Medicaid — our country’s largest funding source for public mental health services. Similarly to the House-passed American Health Care Act (AHCA), the BCRA included a proposal to convert the Medicaid program to a “Per Capita Cap” for the states — only with an even lower, more devastating annual adjustment to the cap than in the House bill.
Just how many would have been affected? Of the almost 69 million people who receive services from Medicaid, one third live with a mental health condition or substance abuse problem. That includes 1.75 million U.S. veterans — almost 1 in 10 — who rely on Medicaid for their only mental healthcare coverage to address PTSD and other trauma-induced illnesses.
Essentially, the bill was nothing short of cruel and unforgiving to the weakest and most vulnerable populations, including the poor and the elderly.
Thankfully, and perhaps not surprisingly, it didn’t have the votes to move ahead on the Senate floor, rendering the proposed piece of legislation officially dead as of last week. But mental health is not out of the woods yet.
In the days that followed, Senate leaders promised to vote to repeal the Affordable Care Act (ACA), also known as Obamacare, without replacement. The proposed repeal would include a two-year delay “to provide for a stable transition period to a patient-centered health care system.” That’s two years that tens of millions of people would be forced to surrender much needed healthcare, including access to critical mental health services that help them stay employed, in school and leading productive lives. It was not a matter of “if” they voted to repeal it, they said, it was a matter of “when.”
By now, it’s clear that certain leaders in Washington are dead set on eventually cutting or altogether eliminating healthcare services — and mental health will certainly be one of the first to see the chopping block. This is nothing short of alarming on multiple levels.
From a mental health perspective, the inevitable fallout from severely cutting or eliminating the ACA will further jeopardize vulnerable populations, increasing their risk of suicide, hospitalizations, unemployment, homelessness and substance abuse.
What’s more, it will place a greater strain on our already overburdened emergency facilities and law enforcement agencies, while needlessly filling jailspace that could otherwise be used for serious criminals.
In short, eliminating the ACA would be nothing less than a travesty for our already fragmented and precarious mental healthcare system. It will in no uncertain terms, worsen the escalating healthcare crisis. And at the end of the day, we all will pay for it.
Instead of slashing precious services, we need to move forward with progressive legislation that increases access to mental healthcare. Costly? Not if you take into consideration that it will mean fewer emergency room visits by the poor and indigent. It will mean fewer arrests of mentally ill, reducing the taxpayer burden of filling jail space. It will mean that more people living with mental illness can work, go to school and raise families, contributing to the economy and their communities.
Because among other things, a true universal healthcare plans will enable access to therapy and medication — the kind that my daughter is taking for an otherwise crippling bipolar disorder. Something as simple as this allow people to manage their mental illnesses, bringing them that much closer to living healthy lives.
