After weeks of promising a plan that would successfully replace the Affordable Care Act and bring quality health insurance options to every American, the republican-led legislature finally unveiled their vision for the future of healthcare in the form of the American Healthcare Act of 2017. Since its roll out, there has been rampant bipartisan criticism of the legislation; some from those who say it doesn’t go far enough to reverse the course of Obamacare and some from those who say it jeopardizes insurance accessibility for tens of millions of people. For those who have benefitted from the increased access to addiction and mental health treatment under the ACA, it’s hard to say that this law offers a happy ending.
Under the new law, the current requirement that Medicaid cover basic addiction and mental-health treatment services would be eliminated in 2020. It would be left up to the states to decide whether they want to provide such services. The republican plan would also eliminate the Medicaid expansions embraced by 31 states and Washington DC under the ACA. With the elimination of the expansion comes a major rollback in treatment access for vulnerable Americans everywhere. The move would represent a significant step backwards in dealing with the addiction epidemic that continues to consume this country at record levels, specifically heroin and opioid painkillers.
Under the current Medicaid expansion, nearly 1.3 million Americans receive treatment for mental illness or substance abuse. For their own part, republicans argue that the change would give states additional flexibility in coverage decisions and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed. Many republican governors who took advantage of the Medicaid expansion in their states are opposing the plan, or at least that aspect of it, and are urging congress to come up with something else. According to a recent scoring from the Congressional Budget Office, the American Healthcare Reform Act of 2017 will result in the loss of insurance of as many as 14 million Americans in the short term and as many as 24 million by 2026.
The bottom line is that treatment access should be made easier not more difficult. A legislative rollback of this magnitude can increase wait-times, eliminate access to treatment, create more addicts and further contribute to the bloated incarceration culture that’s been the hallmark of US drug policy for years. If we truly regard addiction as a disease, it must be treated in accordance with all other long and short-term conditions.