Senator Rand Paul has shared his plan for a replacement to the Affordable Care Act. While I commend the senator for starting a dialogue that includes specifics, there are elements of the plan that should cause mental health advocates to shudder. Three components of the plan that have me cringing include:
Eliminates the Mandate That Everyone Has Coverage: The elimination of the “coverage for everyone” mandate will undoubtedly be a central theme for all of the Republican plans that are being discussed this week and is likely dead on arrival with any of them. Still, it sends a troubling message about our commitment as a nation to ensure health care coverage for all.
Eliminates Minimum Standards for Which Services a Plan Must Cover: Yes, this will make plans cheaper, but how many mental health advocates can look themselves in the mirror and say that this is even remotely a good thing for ensuring that families and children get quality coverage protection?
Eliminates Some of the ACA Standards for Pre-Existing Conditions: Paul is proposing a two-year period where people with pre-existing conditions could get coverage. After that, people with pre-existing conditions would maintain protection as long as they keep their coverage. But what happens to those with pre-existing conditions that don’t sign up during this two-year window of time? A fundamental strength of the Affordable Care Act is that it protects people who are uninsured and signing up for the first time.
The Paradox of Relying on Medicaid While at the Same Time Relaxing State Standards
In a conference call with Republican leaders, Paul was reported to have stated that he believes the best way to deal with very sick people with pre-existing conditions will lie with Medicaid and the states who can “look for innovative ways” to provide necessary care without bankrupting the system. Senator Paul is also reported to have said that he wants through the bill to “give new flexibilities to states in their Medicaid plan design, through existing waiver authority in current law ... [to] allow states to make changes to their Medicaid plans without interference from Washington.”
Senator Paul is telling us that he believes that Medicaid is the answer for those with pre-existing conditions and that states should be allowed to make changes to their Medicaid plans without interference from Washington. Sounds good, right? Wrong.
This mantra of “letting states decide” is good political theatre, but very precarious for those who have loved ones with mental health challenges. History has shown that providing quality health care coverage for those with mental health challenges is far too often at the bottom of the priority list when states are not bound to minimum standards. The zeal to “let states decide” is the Trojan Horse that will likely be inserted into all of the Republican plans coming forward, and mental health advocates should pay close attention.
Senator Paul deserves props for at least publicizing a replacement approach for the ACA that can help start a dialogue. But his plan and likely many of the alternative plans to the ACA that will emerge over the next few days have some significant flaws that should concern all mental health advocates, regardless of political affiliation.
Call Your Congressional Representative
When you call your congressional office today, share the importance of finding ways to increase coverage for as many Americans as possible, keeping minimum standards high, and protecting all Americans with pre-existing conditions, so they are not shunned by the health care delivery system.