This week, Congress passed the 21st Century Cures Act, now headed to the President’s desk. The bill takes a number of steps to improve research and care quality in the healthcare system. Lesser known, the final agreement included mental health reforms that have been in the works for several years. These include helpful changes to advance behavioral health care such as improved primary care-mental health integration, infant-early childhood mental health, maternal depression screening, and a helpful clarification of the EPSDT benefit for children in inpatient mental health institutions.
While the bill takes some important steps, it’s hard to fully celebrate its passage as we face the threat of promised attempts to pull the rug out from under our current healthcare system, and the nation’s most vulnerable families have the most to lose. Rather than make additional progress, ACA repeal and the Medicaid financing changes would gut the ability of the healthcare system to improve access to mental health and substance abuse services (including treatment for things like opioid abuse recently making headlines). Under ACA repeal—currently on the table with no clear plans for simultaneous replacement – parents and other adults who have been able to access affordable coverage through the marketplace or Medicaid expansion would be left out in the cold, with no access to coverage for mental health or substance abuse treatment. A recent analysis estimates that ACA repeal would cause nearly 30 million Americans to lose coverage in 2019.
Beyond repeal, proposals to revamp Medicaid’s financing structure could cut up to one-third of federal contributions to the program in out years, passing costs on to states that would be forced to cut eligibility, benefits, or provider rates. Even before the ACA passed, Medicaid was the largest payer of behavioral health services in the U.S.—sure to have only increased with the passage of ACA and Medicaid expansion. Cuts would make accessing mental health services more, not less, difficult.
In passing mental health reform, lawmakers on both sides of the aisle touted its role in improving access to mental health and substance abuse treatment. While the Cures bill marked bipartisan progress, divisive health care battles ahead threaten to undermine the existing mental health system – not to mention needed improvements that are necessary to fully support the health and development of children and their families. It’s somewhat akin to tossing drowning victims a life raft with a hole in it. The raft will keep them afloat for a while but is not a full-fledged rescue plan.