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The NYSPA Report: Repeal and Replace Should Not Harm Our Most Vulnerable

I am honored to serve as editor of the NYSPA Report and I want to begin by thanking my friend and colleague, Dr. Barry Pearlman. Barry has served as editor of this column since its inception and has provided useful and interesting information since day one.I’m proud to have the opportunity to continue this tradition.

Let me now tell you a bit about me. I am privileged to serve as the Vice President of the New York State Psychiatric Association. I also serve as President and CEO of The Brain & Behavior Research Foundation, the largest private funder of mental health research grants in the world. In addition I am the Editor-in-Chief of the American Psychiatric Association’s Psychiatric News, Associate Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons and host of the Public Television series “Healthy Minds,” a program designed to educate the public and about mental illness, to reduce stigma and prejudice, and to encourage people to seek help and not suffer in silence.

When thinking about vulnerable populations, priority number one is making sure that these people have access to the health care that they need and deserve. This is critical.

As we go to press, Congress is looking at repealing and replacing the Affordable Care Act (otherwise known as the Obamacare). In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure equal coverage of treatment for mental illness and addiction. This Act required health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care. The Affordable Care Act further expands the MHPAEA’s requirements by ensuring that qualified plans offered on the Health Insurance Marketplace cover a list of Essential Health Benefits which include mental health and substance use disorders. The potential repeal and replacement of this Act directly affects much of our nation’s vulnerable populations who live on Medicaid – the largest payor for mental health and substance use services in the country.

The American Psychiatric Association put out a press release on March 7th noting our deep concern that the replacement for the Affordable Care Act will “negatively impact care for people with mental illness and substance use disorders and urges continued support and expanded access to quality, evidence-based mental health and substance use services.”

Discussions on applying significant reforms to the current Affordable Care Act and Medicaid raise the possibility that a large number of people with mental illness will lose some or all of their coverage. It has been estimated by the Congressional Budget Office that 24 million people will lose coverage under the new proposal.

As efforts are made to reform health care, services for people living with mental illness – and their families – must be maintained. The American Psychiatric Association press release offered the following recommendations, which are imperative:

  • Maintain the current level of coverage for mental health and substance use disorders in health insurance plans.
  • Maintain safeguards in private insurance by specifically prohibiting the following:
  • Denying coverage based upon a pre-existing condition;
  • Establishing lifetime and annual dollar limits on essential health benefits; and
  • Discrimination based upon health status, including history of mental illness or substance abuse.
  • Any efforts to restructure Medicaid must ensure sufficient funding for mental health and substance use issues and not shift the cost to states in a way that forces them to tighten eligibility requirements, provider reimbursement, or benefits.
  • Ensure full implementation and enforcement of the bipartisan Mental Health Parity and Addiction Equity Act, which calls on insurers to offer coverage for mental health care on par with coverage for any other ailment.

The American Psychiatric Association notes that the replacement bill, the American Healthcare Act, does keep some positive provisions of the Affordable Care Act intact, such as the provision that allows for preexisting conditions and allowing young adults to stay on their parents plan until age 26. However, it is also important to note that this bill would strip away affordable access and Medicaid expansion, two key provisions that are directly related to mental health.

We must strongly advocate on behalf of our most vulnerable people to make sure than any changes to the health care law do not leave people behind. The New York State Psychiatric Association and the American Psychiatric Association will continue to work with other advocacy groups to support policies that will help make sure that our nation’s most vulnerable populations have access to quality mental health care.

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