Last December, Louisiana Senator Bill Cassidy stood with members of both political parties to announce the passage of the Helping Families in Mental Health Crisis Act. NBC News called it the "most significant mental health reform bill in decades."
Among other things, its many provisions included the way Medicare and Medicaid treat the mentally ill. The act also enabled the federal government to give money to states to serve those with serious mental illness. Additionally, millions of dollars went to the National Institute of Mental Health for research on violence and mental health issues.
Members of Louisiana State University's Department of Psychology served as Cassidy's consultants during the process of the bill's passage. They called him "a champion for improved mental health services." The National Alliance on Mental Illness (NAMI) also approved of Cassidy's role. They cited him as a "leading advocate for mental health reforms in the Senate."
In November 2016, Cassidy, a medical doctor, remarked, "The largest problem affecting Americans with serious mental illness is lack of access to care." He also noted that for him, "passing comprehensive mental health reform has been a priority since day one."
Given all this, it's shocking to see the hypocrisy in Cassidy's proposal (co-sponsored with fellow Republican Lindsay Graham) to repeal the Affordable Care Act (ACA). There is nothing in this replacement for the ACA that supports those with mental illnesses. As NAMI's National Director of Advocacy & Public Policy put it, this "bill will make it harder for people to get psychiatric medications, case management, and mental health services—and other people with mental illness will lose their coverage entirely."
Under the Graham-Cassidy bill, states would have the option to cut mental health coverage to those on Medicaid and the Medicaid expansion would be replaced by block grants. While states could use the block grants for mental health assistance, the proposal doesn't demand they do so. Finally, Graham-Cassidy allows the possibility of states to discriminate against those with preexisting conditions, including mental health conditions.
Cassidy has come out in defense of the bill, claiming it would protect such individuals. "Knowing that states may want to experiment, we specify that in the waiver request [to opt out of Obamacare regulations] they [the states] must have adequate and affordable coverage for those with preexisting conditions."
Yet the bill doesn't define what "adequate and affordable coverage" means, which is troublesome. If mental health care is available under Graham-Cassidy, the coverage could be pricey and would depend on one's definition of "affordable." As Michael Hiltzik wrote in the Los Angeles Times, the idea of states requesting waivers is "an invitation to states to allow insurers to market junk insurance to their residents."
It's also foolish to suggest insurance companies will step up on their own to cover everyone. Before the ACA, insurance plans for individuals excluded mental health care 38 percent of the time, per the Kaiser Family Foundation. Graham-Cassidy, a bill proposed by "a leading advocate for mental health reforms," appears to chart a path back to something resembling that unfortunate past.
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