The Future of the ACA

It is very clear to me that everyone is getting pretty nervous—and rightly so. The news outlets have been overrun with announcements about the Republicans’ intent to repeal and replace the Affordable Care Act (“Obamacare”), and at press time actions to start chipping away at the law had been taken already. The details on what the replacement will be, however, are yet to be worked out, never mind delineated.

Emails from our members have been cramming my inbox with questions. Reporters are calling APA wondering what the repeal of the ACA would mean for access to mental health care for the millions of Americans with newly acquired insurance coverage. If many of those with insurance today were to lose it, would mental health parity have any meaning? Wouldn’t those with mental health needs be disproportionately affected by the repeal of the law, were it not to be replaced by something robust?

What, you might ask, is APA doing about it?

We have joined a coalition of medical associations: the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, and the American Osteopathic Association of Addiction Medicine to communicate our concerns to the leadership of both chambers. APA and its partners are working hard to provide data to our legislators about both the potential intended and unintended consequences of repealing the ACA.

One part of our strategy is to remind the leadership of the crucial step that was taken this past December, with the overwhelming support of both the House of Representatives and the Senate, to enact the 21st Century Cures Act. This is proof positive that improving mental health care and access to it is not a partisan issue. As well, APA has been working to make sure that our leaders stay focused on the need to stem the opioid epidemic that is devastating this country and the equally grim suicide epidemic, which has received much less press coverage but is just as horrific.

Specifically, APA and its partners have advised the leaders of both chambers to make sure that any plan that is endorsed include equitable access to a broad spectrum of treatment services for mental health disorders, including substance use disorders. We have stressed that these services need to include psychotherapy and psychopharmacological treatments and that all these services must be covered on par with other medical disorders, as required by the Mental Health Parity and Addiction Equity Act.

Another aspect of the strategy is to make sure that our legislators know that ensuring access to psychiatric treatments saves money, due to its return on investment in terms of enhanced productivity, reduced overall health care costs, and other economic benefits. We specifically quote eye-opening data. For example, we provide information from an analysis by the Substance Abuse and Mental Health Services Administration demonstrating that for every dollar spent on mental health care, $3 to $5 is generated in new economic contributions and people live longer, healthier lives. We also stress the recent Surgeon General’s Report on Alcohol, Drugs, and Health, which revealed that for every dollar spent on substance use disorder treatment, there is a savings of $4 in health care costs and $7 in criminal justice costs.

But the most important part of the strategy is this: APA is engaged and committed to working with the next Congress and administration to ensure that the needs of our patients and members are addressed. We are at the table. ■