House bill more about politics than policy

White House officials said that the House healthcare bill would see a vote on Friday in spite of growing opposition. The forward press might turn out to be a pyrrhic victory, however, because the bill is unlikely to pass the Senate, according to Julius Hobson, senior healthcare lobbyist with Polsinelli.

“It’s become a case of ‘We have to get it done,’” Hobson tells Behavioral Healthcare Executive. “It’s less about policy and more about politics.”

Although constituents have voiced concerns about the bill at town halls and in communications to Congressional leaders, their input doesn’t seem to be having influence, he says.

Hobson also says if the American Health Care Act (AHCA) does make it through the House—an outcome that seems unlikely as of Friday morning—the Senate bill would end up being quite different. For example, the 10 Essential Benefits that originated with the Affordable Care Act would remain in place, and according to procedural rules, a separate piece of legislation would be required to change them.

And behavioral health advocates still have plenty of cause for concern.

“The way the House bill is structured, people on Medicaid have a very good chance of losing their mental health benefits,” Hobson says.

In AHCA, states would choose between federal block grants or capitated funding for their Medicaid programs—a model not previously employed for Medicaid. The measure limits the contribution of the federal government to a fixed amount and is estimated to reduce funding by $880 billion according to Congressional Budget Office (CBO) estimates. With the new formula, the cuts could come at the worst time for states.

“If a state exceeds its capitated level for one year, then it’s subject to a cut the next year,” Hobson says. “And there are no exceptions to that.”

For example, a significant natural disaster, such as a hurricane, would drive up Medicaid costs during the year, which would then cause the state to lose federal funding in the next cycle. In such cases, states—which are obligated to balance their budgets each year—would have little choice but to cut back on Medicaid services, which Hobson says would likely include mental health and addiction treatment.

“That is unfortunate given the efforts that were made to enhance mental health coverage last year,” he says.

During the AHCA markup Thursday, the House Energy and Commerce Committee added language to permit states to use $100 billion from the Patient and State Stability Fund to expand mental health and addiction treatment, plus another $15 billion that was added on solely for mental health, addiction treatment and maternity care. Critics point out that the amounts do not offset the projected $880 billon that would be cut from Medicaid overall.

Lost coverage

CBO also estimates 24 million fewer people will have insurance coverage—a point the White House says reflects the fact that Americans will no longer be subject to the individual mandate. However, history proves that individuals who don’t have health coverage, whether by choice or because of program cuts, end up using hospital emergency rooms for all their care. Emergency departments are the most costly and least efficient settings.

But no one seems to be discussing the big-picture fallout of reduced coverage in terms of system costs down the road.

“It hasn’t registered,” Hobson says. “The bill shoves a lot of responsibility and costs onto the states, and at the same time, people are losing their access to insurance.”