This was a pivotal week for healthcare with Congress starting to repeal the Affordable Care Act (also known as Obamacare) and North Carolina Governor Roy Cooper moving to expand Medicaid in our state. Regardless of your opinion on these changes, it is true that key parts of the ACA were landmark achievements for people with mental illnesses. These portions of the law are not only working, but they are commonsense, bipartisan solutions to one of our country’s greatest challenges.
There is a growing mental health crisis in our nation. Mental illnesses are among the most common and disabling disorders in medicine. They are at the core of the two leading causes of death among young adults: accidents (including drug overdoses and motor vehicle accidents) and suicide. Every day, at least 78 people die from a narcotic overdose in our country, and that number has nearly quadrupled in less than two decades. In this newspaper last year, Sen. Thom Tillis described the situation as a full-blown epidemic with more North Carolinians now dying from drug overdoses than car crashes. Additionally, someone commits suicide every 13 minutes, and this tragedy has touched many of our local high school communities. Even in our region, which has some of the highest ranked hospitals in the nation, I still routinely see patients with mental illnesses spend days in the ER before a psychiatric bed becomes available. Parents still wait three months or more to get their child in to see a therapist. Many, including members of my family, have driven hours to find available providers. Additionally, there are many hard-working, middle class families that have to spend down their resources to qualify for Medicaid because their private insurance does not cover life-saving treatments.
Mental health reform has been a bipartisan, necessary response to this growing epidemic. It was President George W. Bush who signed the landmark Mental Health Parity and Addiction Equity Act of 2008 that bans financial discriminations in large group insurance plans targeted towards people with mental illnesses. More recently, it was Republican Representative Tim Murphy from Pennsylvania who championed mental health and led a bipartisan coalition that passed the 21st Century Cures last month with nearly unanimous support in both chambers. This is an issue about people, not politics.
To continue making progress, we must cut through the polarizing rhetoric about the Affordable Care Act. There are critical provisions in the ACA that improve mental health insurance coverage and access to treatment. These include extending Bush’s parity law to the small group and individual markets where many contractors and small business employees obtain insurance. The ACA requires all small group and individual insurance plans to cover mental health and substance abuse treatment as an essential health benefit without annual or lifetime limits. It bans discrimination against patients with preexisting conditions – a practice that was disproportionally used to target people with mental illnesses. Finally, there are mechanisms in the law that help people afford insurance through premium subsidies and the Medicaid expansion.
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The population served by Medicaid has a disproportionate number of people living with the most severe forms of mental illness. The Department of Health and Human Services has estimated that 144,000 people with mental illness in our state alone will gain coverage from Governor Cooper’s executive action. After reviewing the evidence, Republican Governor Chris Christie of New Jersey said, “I’d say expanding Medicaid was what was best for the people in my state. I took an oath as governor to do what was best.” John Kasich’s and Mike Pence’s states did the same, and now North Carolina is poised to follow suit. Clearly, expanding Medicaid does not have to be a strictly partisan issue.
Donald Trump and Paul Ryan have promised to keep key, popular provisions of the ACA alive. I believe that the mental health reforms must be on that list. A growing movement of patient advocates, family members, students and healthcare providers agree, and we are organizing a grassroots effort to make sure Congress listens. These reforms will improve the quality of life of patients, families, and our community.
Samuel Joshua Dotson is a student at the UNC School of Medicine’s Charlotte campus. Learn more and sign a petition at SaveMentalHealthReform.org.