Cuts in Coverage Would Hammer Rhode Island
Commentary in The Providence Journal by Ruth Feder and David Spencer.
The Republican proposal to repeal and replace the Affordable Care Act (the ACA) with the American Health Care Act has been withdrawn. For consumers of behavioral health services, this is very good news. This plan would have dramatically reduced the number of individuals who receive mental health and substance use disorder treatment. For individuals with these serious health issues, it would have also created a significant barrier to access to behavioral health care.
It is imperative that any future attempts to weaken or eliminate the ACA consider that it has led to significant increases in access to coverage and treatment for persons who live with mental illness and/or substance use disorder. In states that have expanded Medicaid, the share of people with a substance use disorder and/or mental illness, who were hospitalized without insurance coverage, fell from about 20 percent in 2013 to 5 percent by mid-2015.
The Medicaid expansion has been associated with an 18.3 percent reduction in unmet need for substance use disorder treatment services among low-income adults. Rolling back the Medicaid expansion and fundamentally changing Medicaid’s financing structure so that it caps spending on health-care services will certainly reduce access to evidence-based treatments, and it will reverse much or all progress made last year on the opioid crisis, as cited by the National Council for Behavioral Health.
As reported by the Substance Use and Mental Health Leadership Council’s opioid treatment member organizations, to date 5,000 individuals are seen daily, half of whom are covered by Medicaid. If the “essential benefits” of the ACA are not retained, these individuals will lose their coverage and likely would be at risk for relapse.
Less than a year ago, it was reported that Rhode Island Gov. Gina Raimondo referred to the opioid overdose crisis as the most urgent and unanticipated priority she has faced during her gubernatorial tenure. We predict that that we will witness a dramatic increase in overdoses and deaths in Rhode Island if the ACA’s coverage of behavioral health is weakened.
In Rhode Island, according to a 2015 report by the Substance Abuse and Mental Health Services Administration, about 81,000 adults with any mental illness received treatment each year from 2010 to 2014, and 4,000 adolescents (aged 12-17) received treatment each year for depression. This alone totals approximately 8 percent of the population. The total for alcohol and substance use disorders for the same ages was 11 percent.
According to Mental Health America, there are only two states ranked worse than Rhode Island for the prevalence of mental illness among youth. The rates of death by suicide, drugs, or alcohol among young adults in Rhode Island are soaring, and the prevalence of mental illness in Rhode Island for adults ranks as the worst in the United States (except for Oregon). For adults who report substance use disorders, Rhode Island ranks worst in the nation next to the District of Columbia. It is obvious that reducing or eliminating behavioral health treatment services would significantly limit access and have a devastating effect on our population.
If those who suffer from these illnesses are not treated, the ultimate result would be a dramatic increase in expensive emergency room visits, hospitalizations and deaths. From a policy perspective, this approach is “penny-wise and dollar-foolish.” The impact of reducing or eliminating coverage would inevitably reach into other areas of society and state government. Undoubtedly, there would be increases in interactions with the criminal justice system and the Department of Children Youth and Families, and increases in unemployment and homelessness. As it stands, too many people already have been unable to access behavioral health-care treatment and inappropriately reside in the prison system.
The impact of any health plan proposal that reduces behavioral health benefits does not even begin to measure the cost of human suffering that would inevitably result. We strongly urge policymakers to reject any future efforts to dismantle the current system that serves the behavioral health-care needs of Rhode Islanders.
—Ruth Feder is executive director of the Mental Health Association of Rhode Island. David Spencer is president and CEO of the Substance Use and Mental Health Leadership Council of Rhode Island.