– By Lise Millay Stevens
There were three firm holdouts, the Congressional Budget Office had just issued a scathing report, and more senators were threatening to jump ship. As the drama built and the ‘no’ votes accumulated, Senate Majority Leader Mitch McConnell called for delaying the vote on the Better Care Reconciliation Act, the Trump administration’s attempt to repeal and replace President Obama’s Affordable Care Act. America’s most vulnerable populations—the elderly, the poor and those with pre-existing conditions—exhaled in collective relief.
But the fight for affordable and comprehensive health care is far from over. Political watch dogs predicted that over the July 4 recess, McConnell and company will be cutting deals and twisting arms to get the job done. It may not be easy; over the recess, Senators going home over the break will have to deal with constituents who are concerned about losing their coverage, and being able to afford care in the future. All week, as the bill neared a vote, residents from several states made the trek to Washington to stage sit-ins in senators’ offices and hold protests on the Hill.
The report from the CBO gave may steadfast Republicans the jitters over voting for the BCRA; the agency predicted that, if passed, the $772 million cuts to Medicaid in the bill would make health care unaffordable for low-income individuals and families, forcing millions to drop their coverage; increase premiums for people 65 years of age and younger; and cut Medicaid funds for all 50 states, which would cause millions to be dropped off the program and physicians to opt out at the prospect of lower reimbursement rates for their services.
Three GOP senators—Susan Collins (Maine), Dean Heller (Nev.) and Rand Paul (Ky.)—had already vowed to vote against the bill. With Democrats in unanimous opposition, McConnell’s coalition could only lose two Republican votes. The original challenge was to sway one of the three to vote ‘yes’ on the legislation. On Monday afternoon, however, the CBO released its devastating assessment, and the party’s faithful began to waver.
By Tuesday morning, the floodgates had opened. Senators Mike Lee (Utah), Dan Heller (Nev.), Jerry Moran (Kan.), Ted Cruz (Tex.) and Ron Johnson (Wis.) joined the holdouts. Senators Rob Portman of Ohio and Shelley Moore Capito of West Virginia also defected. Both legislators hold office in states that are the apex of the opioid epidemic. The deep cuts to Medicaid would have decimated coverage for mental health and addiction treatment. Currently, 30 percent to 60 percent of individuals receiving addiction care are covered by Medicaid.
The American Society of Addiction Medicine, the American Psychological Association and the American Medical Association, among other, opposed the BCRA in part because it would drastically cut health services for the most vulnerable Americans, including those with mental health and addiction issues. More than 60 percent of people with substance use problems have an underlying mental health diagnosis. Both conditions needed to be treated concurrently to place these patients on a path to wellness and a productive, healthy life.
According to a 2016 report from the U.S. Surgeon General’s office, approximately 21 million Americans struggle with addiction—more people than are living with all cancers combined.
Cutting funding for behavioral health and addiction treatment at a time when the U.S. opioid crisis is sweeping through every state, shattering communities and destroying families, seems ill-advised. According to a recent analysis by the New York Times, overdose deaths exceeded 59,000 in 2016 (a 7.4 percent increase from the 52,000 in 2015) and are on target to hit 70,000 this year. The number of Americans with substance use issues has been growing exponentially since 2000; the introduction and availability of cheap synthetic opioids such as fentanyl has fueled the problem, which is spiraling out of control in numerous states.
The Senate bill was crafted behind closed doors by a group of 13 all male Republicans, without public comment, input from a single medical organization, patient advocacy group or federal health care agency. In light of the unpopularity of the BCRA with the public and now several Republicans, and with more time for more scrutiny of the CBO report, one can only hope that a more ethical and humane piece of legislation will emerge. The protests are bound to continue, the criticisms will pile up and awareness will rise. Not to mention the biggest motivator of all – the 33 Senate and 435 House seats up for grabs in 2018.
About Sovereign Health
Sovereign Health’s mission is to provide a broad spectrum of high-quality behavioral health treatment services for adults and adolescents, including support services for family members. One factor that differentiates Sovereign from other treatment providers has been the company’s ability to offer separate mental health and addiction or dual diagnosis treatment programs at its facilities. Sovereign’s facilities are licensed and have been awarded Gold Seal accreditation by The Joint Commission, the highest level of accreditation available in the behavioral health field. For more information, visit www.sovhealth.com.