DONALD TRUMP, THE GOP, AND MENTAL HEALTH INSURANCE
]IL Mental Health Counselors Association
Box 706 DeKalb, IL 60115
Washington health care interests are analyzing last night’s stunning election results and a consensus is quickly emerging on the leading issues for consideration in January by the new President and Congress. Most importantly, GOP control of both Houses of Congress and the White House greatly improves the odds of repealing the Affordable Care Act (ACA) or Obamacare. Several months ago, Donald Trump released his health reform outline to repeal the ACA, but the statement lacked many critical details, making a serious analysis impossible to render. However, many experts concluded that it would likely wipe away insurance coverage for over 20 million beneficiaries now covered by the six-year old law. Trump’s outline included seven major features, including repeal of current Obamacare coverage requirements, restoration of preexisting condition exclusions, selling plans across state lines, allowing the return of medical underwriting, (allowing insurers to charge subscribers more when they’re at higher risk of incurring higher than average claims; and promotion of health savings accounts.
At most immediate risk is the coverage of 20 to 25 million Americans who could lose their health insurance (and their mental health benefits under the current law) because keeping the insurance ban on pre-existing condition limits will not help unless there is a mandate to purchase insurance. Repealing the Medicaid expansion program is also included in the estimated loss of 20-25 million beneficiaries and the plan also calls for block granting basic Medicaid payments to the states. Also likely to be lost is the current essential health benefits mandate that includes mental health and substance abuse benefits at parity levels. Other health care delivery reforms now funded through the ACA will be slowed and integration of health and mental health delivery could experience a dampening effect if repealed. See Trump’s outline for health care reform.
OBAMA CARE VS. TRUMP CARE
Current Obamacare does not provide universal coverage; and in 2018 the Congressional Budget Office estimates it will leave 27 million people uncovered. Still, it does outperform “Trumpcare,” which would add 21 million more to that group, totaling 48 million uninsured Americans. Budget analysts calculated about a million of those who lose Obamacare would gain insurance through Trump’s proposal to allow insurance plans to be sold across state lines, which permits consumers in high benefit states to purchase less expensive coverage out of state. For mental health consumers, bare bones plans usually exclude mental health benefits, forcing them into higher risk groups with much higher cost plans.
During the transition to the Trump Administration, Trumpcare is expected to remain in outline form and the new Congress will likely decide details of the final repeal and replace legislation. GOP Hill staff expect the repeal and replace components would be considered in separate bills, since repeal is relatively simple and the replace plan will need much more careful consideration. House Republicans also released their own reform plan developed several months ago see: “A Better Way.” It includes key health policy prescriptions that have long been common in conservative plans, such as block-granting Medicaid and allowing insurance sales across state lines.
CHILDREN’S HEALTH INSURANCE PROGRAM
The Children’s Health Insurance Program (CHIP), a federal-state program that Hillary Clinton helped advance before Congress during her husband’s administration is up for renewal in 2017. CHIP covers more than 8 million children from low- and moderate-income households and has greatly reduced the number of uninsured children over the last 20 years. According to the Census Bureau, nearly 95 percent of children had insurance coverage in 2015. That year Congress compromised between those arguing to extend CHIP and those who wanted to end it, by renewing it for only two years. That authorization ends Oct. 1, 2017. In practice, if Congress wants to extend CHIP, it needs to act early in 2017 because many states have fiscal years that begin in July, and they need lead time to plan their budgets. With Trumpcare calling for block granting Medicaid, Congress may decide to eliminate separate CHIP funding and include it in the new health block grants to states.
By Daniel Stasi, 11/13/16
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