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ACA Replacement Will Slash Behavioral Health Services

From the National Council Capitol Connector:

ACA Replacement Bill Slashes Medicaid, Behavioral Health Services

By Stephanie Pellitt

On Monday, the U.S. House released the American Health Care Act (AHCA) to repeal and replace the Affordable Care Act (ACA). The bill contains provisions that, if enacted, could devastate Americans’ mental health and addiction coverage and care. The proposal pays for reforms in the commercial health care market by dramatically cutting funding from Medicaid, the single most important funder of mental health and addiction services in this country. Approved by the House Ways and Means and Energy and Commerce Committees earlier this week, the proposal is now under consideration with the House Budget Committee.

Republican leadership maintains that the AHCA will complete the committee process and move to the House floor over the next 2-3 weeks. However, divides with the GOP and across party lines raise doubts about the bill’s likelihood of ultimately reaching the White House. Read below for a summary of the bill and information on how you can join the National Council in fighting these potentially dangerous measures.


Refinances Medicaid Into Per-Capita Caps – Fundamentally changes Medicaid financing from an open-ended federal and state matching formula into per capita allotments. Under this new system, the federal government would provide a set dollar amount to states based on its number of Medicaid enrollees. Per capita caps would start in FY 2020 and use each state’s spending in FY 2016 as the base year to set targeted spending for each enrollee category (elderly, blind and disabled, children, non-expansion adults, and expansion adults). The federal caps would only increase each year by the percentage increase in the medical care component of the consumer price index. This proposed growth rate is even lower than what was included in previous version of the bill, putting even more fiscal pressure on states. The goal of this proposal is to massively cut federal spending for Medicaid, potentially leaving millions without needed care.

Restricts Medicaid Expansion – After Jan. 1, 2020, the bill will allow states to continue to receive the enhanced FMAP rate for unique expansion individuals as long as they do not have a break in eligibility for more than one month. The enhanced federal matching rate would only apply to expansion-eligible individuals already enrolled in Medicaid as of Dec. 31, 2019. After Jan. 1, 2020, states could only enroll newly eligible individuals at the state’s traditional FMAP for that individual. Non-expansion states would be provided $10 billion over five years as safety-net funding to adjust Medicaid provider payments; Repeals state option to expand by Dec. 31, 2019. This provision ends the growth of Medicaid expansion and slowly reduces the current Medicaid expansion population, who frequently break in and out of Medicaid eligibility.

Repeals EHB Requirement for Medicaid Expansion plans ­– Repeals the requirement that essential health benefits (EHB) must be provided in Medicaid expansion plans on Dec. 31, 2019. Essential health benefits specifically require health plans to cover mental health and addiction treatment. By removing the EHB for Medicaid expansion, this provision puts Medicaid  expansion enrollees at risk of losing mental health and addiction treatment coverage.

Repeals ACA Subsidies, Creates Refundable Tax Credits – Repeals the ACA’s cost-sharing subsidies in 2020 and creates an advanceable, refundable tax credit for the purchase of state-approved, major medical health insurance. Credits are not universal and are based on age and income-eligibility. Credits – ranging from $2,000 to $4,000 per individual – are available in full to those making $75,000 per year ($150,000 for joint filers). They phase down by $100 for every $1,000 in income higher than those thresholds. The repeal of the ACA’s subsidies limit affordable health coverage options for individuals with mental illness and/or addictions that do not have access to employer-based coverage.

ParityThe bill does not make any changes to the mental health and addiction parity requirements for group and individual health plans.

Maintains Popular Provisions of ACA – Preserves requirement for insurers to accept all consumers regardless of pre-existing conditions and allows children to stay on their parents’ insurance plans until age 26.

Repeals the Individual Mandate ­­– Repeals the ACA’s individual mandate and instead allows insurance companies to charge a 30 percent surcharge if consumers go without “continuous” insurance coverage for two months or more.

Eliminates a Number of ACA Taxes – Eliminates the medical device tax, the tanning tax, a tax on high earners and a tax on investments. Again, these provisions are financed by dramatic cuts to funding in Medicaid.

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