By Dennis Archambault

As legislators sift through the details of the revision of the Affordable Care Act currently proposed by Republican members of Congress, expanded Medicaid is a critical concern for advocates of the health care safety net. Reductions in the expanded Medicaid program over the next decade will not only limit access to health care for millions of low income people, they would eliminate the requirement to provide essential health services
Beginning in 2020, the plan would eliminate an ACA requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.

Thirty-one states, including the District of Columbia, have expanded Medicaid programs, including Michigan. Authority Health has supported Gov. Snyder’s effort to preserve expanded Medicaid. It’s unclear how the governor views the proposed elimination of essential health services.
The Affordable Care Act specifies 10 “essential” health services that expanded Medicaid plans must cover. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, among others. Republicans say that the new reimbursement mode will allow states to determine what they want to offer their beneficiaries. However, experience suggests that mental health care probably won’t factor into the priority-setting.

People who work with low income populations are acutely aware of the toll that chronic stress plays. Often multiple social determinants are constant pressure points: meeting the mortgage payment, or the car payment, or utilities; the stress of getting to a job site or getting children to a good, safe school; and the stress of living without hope.
Mental health conditions contribute to physical health maladies, or may be “phantom” undiagnosed contributing causes of pain and physical symptoms. It’s bad enough that community mental health agencies are understaffed and underpaid for their services to this population, much less removing the capacity to serve.

Society is steadily drifting away from a universal consciousness around health to defining a two-tiered system. There is legislative and community outcry; but that seems to have had little impact on the direction of the new law.

Dennis Archambault is vice president for Public Affairs at Authority Health.