While Senate passage of the Better Care Reconciliation ACT (BCRA) appears to have failed, it is unlikely that the Republican-led effort to repeal and replace the Affordable Care Act (ACA) has seen its last day.
Yet as we watched the U.S. Senate inch closer to a health care vote that never took place, citizens across the country came to the sobering realization that Republican lawmakers’ ideas about “improving” health care in America effectively amounted to stripping millions of American men, women and children of health care insurance — particularly those with low incomes who receive coverage through Medicaid.
Now we find ourselves in yet another period of turmoil and uncertainty. Will the Senate and House attempt a simple repeal on the ACA with nothing to replace it but a vague promise of something better up the road? Meanwhile, the futures of millions of Americans hang precariously in the balance. And it’s not just the potential loss of medical coverage that’s at stake. People in need of mental health and addiction services are at even greater risk of being hurt.
Earlier this month the scope of the nation’s crisis involving opioid addiction was made all too clear here in Brattleboro when 13 people suffered overdoses over the Fourth of July holiday resulting in one fatality. Under the BCRA, resources for addiction services under Medicaid would have essentially been eliminated while simultaneously slashing access to quality health plans for millions.
In response to complaints from Republican lawmakers in states hard hit by drug addiction, the BCRA was amended to include $45 billion in grants over 10 years to address the opioid epidemic. Yet reasonable estimates indicate we will need upwards of $183 billion (probably more in my view) over the next 10 years to effectively deal with a problem that has become massive in scope. According to the Centers for Disease Control and Prevention, legal prescription pain killers now kill more Americans than any illegal drug.
In a political rush to appease certain senators to vote yes on the BCRA, the Republican leadership asked us to believe that throwing grant dollars at a few high profile health problems like the opioid epidemic, while simultaneously slashing Medicaid coverage for more than 20 million Americans, amounted to “better” health care.
Vermont is one of five New England states that took advantage of the Medicaid expansion under the ACA. This allowed thousands of Vermonters to get health insurance coverage. Now it is estimated that 20,000 Vermonters would lose insurance coverage next year alone, and increase to more than 30,000 by 2026, if the ACA is repealed.
And when you realize that nationally, Medicaid covered 3 in 10 nonelderly adults with opioid addiction in 2015, it becomes clear that a state like ours, which has seen a significant increase in opioid-related fatalities in the past 10 years, will be faced with almost unimaginable challenges if legislation similar to the BCRA, which phases out the Medicaid expansion, should become law.
The BCRA also planned to do away with what are known as “essential health benefits.” This is a list of services including mental health and substance abuse treatment that insurers are required to cover under the ACA. It also gave individual states the option to not cover substance abuse treatment. How a state like Vermont, with limited resources, and a declining and aging population, would weather such a storm is hard to predict.
Repeal of the ACA, and the potential passage of a replacement similar to the BCRA, will be paid for in lost lives across the board. It will also threaten to lower our standard of living for people in all 50 states. Fortunately, I see bipartisan opposition to such efforts here in Vermont and across the country. The Scott administration came out against the BCRA as did the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American Hospital Association, the American Heart Association, the National Center on Addiction and Substance Abuse, and countless others.
As a health care professional with more than 30 years of experience, it is clear that the ACA has improved the lives of countless Americans. To the extent that the ACA has flaws, our efforts should be focused on making needed corrections. It’s the only way we can move forward secure in the knowledge that our healthcare system is truly getting better.
This commentary was published in the VTDigger on July 25, 2017 and it was written by Louis Josephson, Ph.D., who is the president and CEO of the Brattleboro Retreat.
