AUGUSTA — The nation watched May 4 as the U.S. House of Representatives narrowly approved legislation to repeal and replace integral parts of the Affordable Care Act. Now the replacement legislation, the American Health Care Act, is in the U.S. Senate’s hands. And there are rumblings that they might take it back up for passage with minimal changes before the Fourth of July.
If the AHCA passes in its current form, nearly 20,000 Mainers would lose critical access, gained through the ACA, to treatment for mental health concerns and substance use disorder, a number cited in research from both Harvard and New York universities in January.
As we have all heard by now, drug-related deaths in our state reached a new high of 376 lives lost last year, an increase of nearly 40 percent and 100 more people when compared with 2015’s total of 272 fatalities. More troubling, 2016 was the fifth straight year of an increase in fatal overdoses, mostly because of the illicit use of prescription painkillers, heroin and the potent synthetic drug fentanyl.
Behavioral health experts call what’s transpiring an acute crisis and recognize it as a devastating trend that must be halted. Medicaid and its unparalleled access to mental health and substance use disorder treatment needs to be protected, or expanded, to address this crisis.
Maine Sen. Angus King, an independent, has said that the iteration of the AHCA proposed by the House would make our state’s opioid problem worse. At present, at least one person dies every day from an overdose in Maine. This is already one too many. No more.
Opponents of the ACA repeal, including King and Maine’s Republican senator, Susan Collins, understand that about 75,000 Mainers receive ACA coverage in general, more than 20,000 are receiving treatment for behavioral health issues, and some 8,000 are actively getting treatment for substance use disorder. The ACA has allowed many who would have been denied coverage because of pre-existing conditions, which includes mental health and addiction issues, to keep their insurance.
Both senators decried the detrimental effects of the House proposal on the poor and on people over age 50. King called for meaningful improvements, while Collins said, “It really misses the mark.”
Because Maine is not a Medicaid expansion state, it only receives a 64.38 percent matching rate from the federal government for MaineCare (the state’s Medicaid program), a prime source of funding for our behavioral health services. These are critical funds, especially as pressures increase upon our already stretched state budget. Had Maine taken the Medicaid expansion, coverage for the newly eligible adults – an estimated 70,000 – would have been fully funded by the federal government for three years, then phased down to a 90 percent matching rate by 2020 and thereafter.
In February, Secretary of State Matthew Dunlap certified that enough signatures have been collected to place a citizen initiative for MaineCare expansion on the November ballot. It’s been passed five times in the Legislature, but vetoed five times by Gov. LePage.
If repeal and replacement of the ACA comes to pass, we’ll lose $5 billion in federal funding for Medicaid, the Children’s Health Insurance Program, financial assistance for marketplace coverage and the option to expand Medicaid. According to the Maine Center for Economic Policy, we have already lost nearly $2 billion that we would have received had the governor not vetoed Medicaid expansion.
The Maine Department of Health and Human Services has increased state funding for addressing our opioid crisis to the tune of millions of dollars, all without the match we would have had under an expansion. Our citizens simply can’t afford this.
Mainers are fortunate that our U.S. senators understand how necessary it is that provisions of the ACA are secured within a new plan, especially real coverage for pre-existing conditions like mental health. Please call Susan Collins and Angus King to affirm your support that any new health care plan protects us all – and especially our neighbors needing substance use disorder treatment and mental health care.
And make sure you go to the polls in November to expand coverage to the tens of thousands of Maine residents who need it.
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