Though the 21st Century Cures Act carries a number of provisions that benefit patients with mental health concerns, a repeal of the Affordable Care Act could negate those gains.
The ACA is on the hot seat after the election of Donald Trump to the presidency and Republicans to control of Congress, so at least a partial repeal of the healthcare law is imminent and could occur as early as the beginning of next year. Despite the passage of the 21st Century Cures Act last week by the Senate, a bipartisan bill that includes measures for mental healthcare, top Democrats told Politico that a repeal of the ACA would be a major blow to patients with mental illness.
"If they go ahead and repeal the ACA, all that we’re trying to do here with this mental health bill is essentially going to be meaningless because there's not going to be any coverage for mental health care," Rep. Frank Pallone, D-N.J., told the publication. "This is a great bill and we worked on it a lot, but it's not going to be worth much if we repeal the Affordable Care Act."
The ACA includes mental health as an “essential benefit,” according to the article, which means insurers must cover it to the same level as other medical care for patients enrolled in ACA exchange plans. The act's provisions that prevent payers from denying coverage for existing conditions extend to mental illnesses as well. Rep. Tim Murphy, R-Pa., a leader in the GOP on mental health, told Politico that he does back a repeal of the ACA but would fight to keep mental health gains in a Republican replacement plan.
Richard A. Friedman, M.D., a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, wrote in a column for The New York Times that the results of a repeal would be “quick and devastating” for patients with mental illness. Part of the concern, he said, is that there isn’t a concrete plan in place to replace the ACA after a possible repeal, leaving millions of mentally ill patients in flux.
The ACA offers patients with mental illness “the most medically rational and humane benefits they have ever had,” he said, and eliminating those benefits with no replacement not only has a profound impact for patients but also for the health system and economy. Mental illnesses are expensive to treat, and patients struggling with mental illnesses are commonly ER “super users,” which makes it a preventable drain on the economy, Friedman wrote.
Providers are concerned about other aspects of a possible ACA repeal, too, including estimates that show hospitals stand to lose billions of dollars if its provisions are rolled back. Trump has said he is willing to keep certain aspects of the health law, including the ACA’s ban on payers denying coverage to patients with pre-existing conditions.