The ACA Debate: Move Forward, Not Back

It's no secret that Congress is debating whether to repeal the Affordable Care Act (ACA) and if so, whether and how to replace it.

NAMI's position is non-partisan and simple. We want to keep what works and make the mental health care system even better than it is today. Significant progress was made when Congress overwhelmingly passed mental health reform in 2016, but health coverage is fundamental to helping individuals and families affected by mental health conditions

The debate is not just a political one. It is a moral one. Lives are at stake. NAMI hears from people every day about its importance. Many Americans fear what may happen if they are forced to return to the days when they couldn't pay for needed medications, visits to psychiatrists and therapists or when a single hospitalization could wipe out a family's savings.

"I don't want to get to the point where I have to be hospitalized again," one man from Michigan told us. A man in Pennsylvania would lose services that have helped him get and keep a job. He says repealing the ACA would reverse progress in the state at a time when "we came so far ahead of many states in treatment."

Losing jobs and losing one's home are major fears.

A California woman wants to keep her independence and avoid becoming a major burden to the state. Without medication and other preventive support, she will have to rely on emergency rooms when she experiences psychosis and probably be hospitalized -- or end up living on the street.

"Why incur more expenses in ERs when we could have cheaper, easier access to care?" she asked. Medicaid expansion, which 31 states and the District of Columbia adopted under the ACA, "has given me life, literally." It has allowed her to participate in activities and maintain relationships. "Without coverage, I would not be able to be a stable, participating member of society."

Lack of necessary health care not only causes carnage in people's lives, it shifts costs elsewhere -- such as schools and the criminal justice system. Businesses also lose productivity; one measure of that cost is the $193 billion in lost earnings alone that results from mental illness each year, hurting the country's economic competitiveness.

One in 5 Americans are affected by mental health conditions, but more than 50 percent receive no treatment. Three out of four people who live with mental illness have symptoms before age 24. Meanwhile, 42,000 lives are lost to suicide each year -- the second cause of death among young people ages 15-24. During the debate on the future of health coverage, everyone needs to keep these facts in mind and recognize the importance to millions of families.

The ACA benefits everyone in some way, including people who have employer-paid health insurance.

Mental health and substance use coverage are required essential benefits for health insurance plans. Market exchange plans also are required to comply with parity -- treating mental health and substance use conditions the same as physical health needs.

The ACA also allows parents to keep covering young adults on family health plans through age 26 during periods of critical education and work transitions. Given that this is the age of onset for many mental health conditions, the provision is critical for early intervention.

The law also prohibits denial of coverage based on pre-existing conditions. This has allowed people to seek treatment they desperately need without worrying that seeking care will disqualify them from the insurance market.

People who previously found individual health insurance out of reach receive subsidies through market exchanges. And through state Medicaid expansions, more people living below or near the poverty line are able to get the care they need.

Medicaid expansion has been especially important for people with significant mental health conditions. Nearly 1 out of 3 persons covered through the expansion live with mental health or substance abuse conditions. People who are homeless and cannot navigate the disability system receive coverage. Others who are at early stages of psychosis can get care -- without having to wait until they are so ill that they can qualify for disability payments. Early treatment helps set young people on a path to education and jobs, not dependence on the government.

NAMI is part of the current debate. Are you? If you recognize yourself in these concerns, now is the time to let Congress know. Keep what works and make the health care system better. Move forward, not back. You can contact your Senators and Representative by email here.