President-elect Donald Trump recently released his plan for his first 100 days in office. Among his listed goals is repealing the Affordable Care Act, more commonly known as Obamacare. This act necessitates action from Congress, but with Republicans controlling both the House of Representatives and the Senate, Trump’s goal will likely be realized. The Affordable Care Act has had a significant effect on mental health coverage and its repeal will come at a cost, especially to those with mental health problems like bipolar disorder.
Donald Trump’s plan to replace the Affordable Care Act includes tax reductions on health care premiums, tax-free health savings accounts, allowing the purchase of insurance across state lines and establishing block grants for Medicaid programs. These policies will take time to come into effect. Even then, these policies will leave major gaps in mental health coverage.
Here are five examples of the consequences of repealing the Affordable Care Act that are relevant to people with serious mental illnesses like bipolar disorder.
1 Bipolar Disorder is a pre-existing condition.
The ACA prohibits insurance companies from denying or charging more for coverage based on pre-existing conditions. If that were repealed, anyone who had at any point been treated for bipolar disorder would risk losing coverage. Bipolar disorder is a very expensive illness. Without insurance, many people simply will not be able to afford treatment. Without treatment, bipolar tends to get worse.
2 Young adults may not be allowed on their parents’ insurance.
Prior to the ACA, insurance companies usually dropped coverage of a child at the age of 19, sometimes older if the child was seeking higher education. With the ACA, all children were permitted to stay on their parents’ insurance until the age of 26.
People with bipolar disorder tend to start showing symptoms around this age and early treatment of bipolar disorder is vital in keeping it under control over a person’s lifetime. Without the ability to afford insurance on their own, many young adults with emerging bipolar disorder will miss this treatment window.
3 People currently receiving Medicaid benefits may lose their coverage.
Medicaid is the number one payer for mental health services in the United States. With the ACA, the federal government offers states financial support in order to expand health care services to low-income individuals. If this expansion is replaced with block grants, it will be up to individual states to control Medicaid benefits. Almost 16 million people were added to the Medicaid program under the ACA. With the repeal, they will likely lose that coverage.
4 Insurance companies may not be required to offer mental health coverage.
As of 2014, the Affordable Care Act required most insurance companies to offer mental health coverage. It also required that this coverage be no more restrictive than medical or surgical coverage. Mental health coverage not only includes receiving inpatient and outpatient care, but also requires coverage for treatment of substance abuse disorder, from which between 48-60% of people with bipolar disorder suffer. Without these requirements in place, insurance companies will be allowed to charge more for coverage of mental illness or drop coverage completely.
5 Screening for mental illness may not be provided free of charge to the patient.
The ACA currently requires screening for depression to be provided at no cost to the patient. Over 60% of patients with bipolar disorder initially see their primary care doctors for depressive symptoms. Without free screening, patients will be required to pay a copay or meet their deductible in order to be screened. In some cases, patients may refuse the service on the basis of lack of funds to cover the cost, leaving them without proper diagnosis and treatment.
There are a few scenarios Congress may choose from in repealing the Affordable Care Act. They may defund a few parts, leaving some of these benefits in place. They may repeal and replace it with plans like the one suggested by Donald Trump or they may repeal it completely.
If the ACA is repealed within the first 100 days of Trump’s presidency, it will be months at least before any legislation for a replacement will go through. As it stands, up to 25 million Americans may lose their health insurance altogether. Everyone will have increased out-of-pocket spending and the program will cost $550 billion dollars over the next decade.
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