Senate tweaks won’t change big cuts to Medicaid

Senate Majority Leader Mitch McConnell vowed to press forward with the chamber’s healthcare proposal, in spite of delaying the floor vote. The extra time could allow for policy tweaks that aim to win over senators and achieve the required 50 votes to pass the measure.

Behavioral health industry leaders are also pressing forward with their opposition, drawing a detailed picture of what healthcare would look like in the United States for individuals with mental health or substance use disorders if the Senate bill is implemented. For example, those in the law enforcement community are concerned that the proposed reduction in Medicaid funding would result in reduced treatment, and therefore, more crisis calls.

“We are community caretakers. We took an oath to do that, and part of that is connecting people to care,” said Joe Coffey, a retired law enforcement officer from the Warwick, R.I., police department, during a conference call with reporters on Wednesday. “But if that care is not available, that is going to make our jobs far more difficult. People who very much need treatment are not going to get it.”

Linda Rosenberg, president and CEO of the National Council for Behavioral Health, called the bill a “reverse Robin Hood,” driving more people into poverty while allowing tax cuts for corporations and the wealthy. What’s more, she said, the proposed grant money earmarked for mental health and substance use disorder won’t overcome the wholesale gutting of Medicaid that’s included in the bill.

Advocates continue to call for behavioral health to be regarded the same way as any chronic condition.

“If I had breast cancer or heart disease, I wouldn’t need a grant to get care,” Rosenberg said. “It would be in my benefit package.”

According to the nonpartisan Congressional Budget Office, the Senate’s Better Care Reconciliation Act (BCRA) would result in 22 million fewer people insured by 2026, and of those, 15 million would lose coverage from Medicaid programs. Significant caps for federal contributions to Medicaid would begin in fiscal year 2020, and Medicaid expansion would be phased out. An estimated $776 billion in spending would be eliminated over 10 years—primarily from Medicaid.

Repeal and replace--not really

The text of BCRA purports to be a repeal and replace of the Affordable Care Act (ACA), said Rebecca Farley David, vice president of policy and advocacy for the National Council, on the call, but the scope reaches beyond that.

“If you look at what elements of ACA this legislation actually touches on, you will see that it is not a wholesale repeal and replace bill, rather, it is a drastic restructuring of the Medicaid program, going well beyond the changes to Medicaid under ACA,” Farley David said. “This shell of a repeal and replace bill has been fueled by this massive undertaking to dramatically cut and gut Medicaid.”

Rosenberg said BCRA is “opportunistic” and has little to do with ACA. Instead, it allows politicians to move their agendas, particularly to end Medicaid as an entitlement program. In addition, she said the Medicaid spending reduction is the mechanism to offset tax cuts in BCRA.

“It’s also a belief that [the tax cuts for corporations and the wealthy] in fact trickles down to jobs in our economy, although there is no history that supports that belief,” Rosenberg said.

The American public has had too little time to digest the policies and implications laid out in BCRA, she said. And the rush toward a Senate vote might be a tactic to prevent deeper discussion and time to bring up new concerns.

More: The least you need to know about the Senate healthcare bill