By Robert J. Budsock. President & CEO of Integrity House
After the contentious 2016 election, we are left with a White House and both chambers of Congress dedicated to repealing and replacing the Affordable Care Act (ACA). While Republicans have insisted on an immediate repeal, they have yet to propose any real plan for replacing “Obamacare.” President Trump has repeatedly called the ACA a “disaster” and during the campaign he vowed to repeal and replace it immediately upon entering office.
Obviously, no repeal has occurred, and in a recent interview, the president stated that the process will start this month, although he has also hinted it may carry over in 2018’s agenda. He also recently called for the House and the Senate to “repeal and replace” the ACA during his first joint address to Congress.
While the nation waits to see what will become of the ACA, it’s painfully apparent to those of us on the front lines of the opioid and heroin epidemic that an outright repeal would create significant headwinds, in all aspects of our healthcare system, but especially in mental and behavioral healthcare.
The most immediate concern would be changes to the Medicaid expansion ushered in under the ACA. In a 2015 tweet, the president vowed not to cut Medicaid. Despite this promise, Speaker of the House Paul Ryan has recently proposed a plan that would strip the program of $1 trillion in funding over the course of the next decade through a budget reconciliation process. At the same time, Congress is discussing changes to the federal Medicaid program which would jeopardize the recent expansion of addiction services in New Jersey and other states throughout the nation.
Some states hit hardest by the opioid epidemic, aside from New Jersey, such as Ohio, West Virginia and Kentucky with Republican governors have also expressed serious concern about rolling back Medicaid expansion for fear of what might happen to those being treated for addiction. Under the current system, the federal government guarantees matching funds to states for qualifying Medicaid expenditures.
Changes in this system would have devastating impacts on mental health and substance abuse services throughout the entire country. Any cuts to the Medicaid expansion on the federal level would take even more resources from the behavioral health safety net – a chilling prospect given the current opioid and heroin crisis that the country faces.
New Jersey, like a handful of other states, opted into Medicaid expansion, and our current system for funding mental and behavioral healthcare is enhanced by the federal funding match that our state receives. Gov. Chris Christie added $127 million into the 2017 state budget for these services and most of this funding is reliant on the federal match from Medicaid. This is the funding that institutions like Integrity House rely on to provide a full continuum of care for clients affected by the state’s current heroin epidemic.
Nationally, people with behavioral health diseases such as addiction make up nearly one-third of those covered under the expansion. That’s reflected through our clients at Integrity House – in fact, even more so because the clear majority of them depend on Medicaid funding tied to the ACA to cover their medical expenses and outpatient addiction treatment services.
Integrity House and our advocacy partners, the National Council for Behavioral Health and Treatment Communities of America are fighting to protect these benefits under the ACA. The lives of thousands of our fellow citizens hang in the balance.
It is clear that repealing the ACA will impact programs like Medicaid and those who so desperately depend on these programs. Lawmakers must consider how components of the ACA, such as Medicaid impact the lives of those in need before simply dismissing it for political reasons and moving forward with a repeal.