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Other View: Repealing the Medicaid expansion will be a disaster for people with mental health problems

Three years ago Chips Drake was unemployed, homeless and suffering from both physical and mental health issues.

Today it is different. Chips says his life changed when he received care through the Medicaid expansion. He got glasses and dentures: small things, but essential. He also received mental health care that helped him work through years of emotional issues. He got back on his feet, returning to school and completing his coursework for a master’s degree in professional counseling.

Now Chips, 58, works full-time for Hope Network, a mental health facility in Flint, Mich., and credits Healthy Michigan with making it possible for him to give back to others. Getting health care through the Medicaid expansion changed his life and the lives of the people he works with every day.

Chips and many others like him are why I went into the mental health field more than 40 years ago. The threat to the Affordable Care Act’s Medicaid expansion is the worst crisis I have seen in my four decades years on the ground supporting the improved delivery of mental health and substance use services.

In recent years, the National Council and our partners in the behavioral health field have made strides toward an America where everyone can get the health care they need, not just for their bodies, but for their minds, too. The Affordable Care Act’s Medicaid expansion helped 11 million people take better care of themselves, but as Congress considers changes to our health-care system, we cannot overlook what a success story the Medicaid expansion has been for people facing behavioral health issues, too.

Repealing the Medicaid expansion would leave millions of Americans with mental health problems in serious danger. In fact, Americans with mental health and substance-use disorders are the single largest beneficiaries of the Medicaid expansion under the Affordable Care Act. Nearly 1 in 3 people who receive health insurance coverage through the Medicaid expansion either have a mental illness, substance-use disorder or both. If the expansion is repealed, these 1.29 million vulnerable Americans will be left without access to lifesaving treatment.

In that case, states will lose an estimated $4.5 billion a year that currently goes to support addiction and mental-health treatment services for enrollees, money that cannot easily be replaced by states that are already struggling under revenue shortfalls and budget gaps. Removing access to mental-health care would also harm the employment prospects of people like Chip, who rely on treatment or medication to keep them well enough to go to work.

On top of that, repealing the Medicaid expansion would halt fledgling progress to combat the opioid epidemic because of the sheer number of people who get treatment for addictions through the ACA’s Medicaid expansion. Cutting spending for addiction treatment in the midst of a catastrophic drug crisis is shortsighted and dangerous.

As Sen. Sherrod Brown, R-Ohio, said: “Repealing the law would immediately interrupt treatment for hundreds of thousands of Ohioans who are struggling with addiction and fighting for their lives. Local communities all across Ohio are doing their part to combat the opioid crisis. We cannot let the federal government pull the rug out from under their work with so many lives at stake.”

The American Health Care Act is not the National Council’s vision for health care in America. The real result is that people will die.

Luckily, many are uniting—across party lines—to protect behavioral health and keep our promise to the millions of people like Chip. The National Governor’s Association has called for Congress to ensure “a meaningful federal role” in financing Medicaid. In fact, sixteen of the states that broadened Medicaid eligibility are led by Republican governors who are standing for its continuation. That includes Michigan Gov. Rick Snyder, R, who said his state saw “a huge increase in coverage,” combined with a huge drop in the number of people showing up at hospitals without insurance—a financial burden that cost hospitals nationwide $50 billion in uncompensated care in 2013. Arizona Gov. Doug Ducey, R, stood up for the 400,000 Arizonans covered as a result of the Medicaid expansion, with a clear message to Capitol Hill: “I don’t want to see any Arizonans have the rug pulled out from under them.” “I just want to know what’s going to happen to all those people who find themselves left out in the cold,” said Ohio Gov. John Kasich, R.

As Congress votes on these issues, they’re also voting on the hopes, dreams and lives of millions of Americans grappling with mental illnesses and addiction disorders. For all of them and for advocates like myself who have devoted their lives to caring for people struggling with these challenges, I hope our government doesn’t vote to abandon its most vulnerable citizens.


Columns
OTHER VIEW
Other View: Don't believe the White House on Manafort

Bloomberg journalists were hosting a series of breakfasts with national political reporters at the Republican National Convention last July and wanted an influential guest for the opening morning. With Donald Trump unavailable, the next best choice was clear: his campaign chairman, Paul Manafort.

Manafort had taken over the campaign and was directing it at a critical time, when Trump wrapped up the nomination and headed off fights at the convention between various Republican factions.

He left the campaign in August amid controversy over his role as hired gun for a pro-Russian political party in Ukraine. This week, The Associated Press revealed that Manafort secretly worked for a Russian billionaire to advance the interests of Russian President Vladimir Putin a decade ago, and proposed an ambitious political strategy to undermine Putin’s opposition.

Now that the FBI has confirmed that it is investigating whether there was collusion between Trump operatives and Russian interference in the presidential election, Manafort has become almost a non-person in Trumpland.

White House Press Secretary Sean Spicer declared on Monday that Manafort had only a “very limited role for a very limited time” in the Trump campaign.

Like many other assertions that have been made from the White House since Trump was inaugurated on Jan. 20, that was false.

Manafort controlled hiring for the Trump campaign, along with its media campaign and budget.

At that July breakfast in Cleveland, it was clear that Manafort spoke for the candidate and knew his thinking. He had been in charge of all the strategy for the convention.

He explained that he had put Trump in touch with Mike Pence, then governor of Indiana and now vice president. “I brought him in to meet Pence,” Manafort said of Trump, adding that the contact led to the notion that the Indiana governor “had value to Trump as a potential VP nominee.”

The breakfast guest the next morning was the Republican Party chairman, Reince Priebus. Priebus told me then how important Manafort was to the campaign, what an improvement from former campaign manager Corey Lewandowski. Priebus is now White House chief of staff.


Columns
OTHER VIEW
Reader Comment: Idaho children and families at risk of losing health coverage

Access to affordable, timely health care is a critical component of our quality of life. At Idaho Voices for Children, a nonprofit program that advocates for children, we are particularly interested in ensuring health coverage for kids and their parents.

As we enter the next wave of national health care reform, we want to make sure coverage gains are sustained and affordability is improved. Earlier this month, we got to see the first proposal that could replace the Affordable Care Act. The nonpartisan Congressional Budget Office analyzed this bill, called the American Health Care Act. The resulting data raise significant alarms about how the proposed policy will impact children and families. Nationally, the bill would cause more than 24 million people to lose their health coverage by 2026, while health insurance premiums rise 15 to 20 percent.

Your Health Idaho is our state’s health insurance exchange providing health plans to 106,000 Idahoans (including 12,000 children). The majority rely on the Affordable Care Act’s tax credits to purchase these plans. Under the AHCA, tax credits to purchase health insurance will diminish in value and will no longer be based primarily on a family’s need. The bill would force almost 60,000 Idahoans off the state health exchange by 2020, according to Your Health Idaho. Your Health Idaho estimates that the average tax credit under AHCA would be $2,956 for an Idaho family of four with an annual income of $50,000. That is a 23 percent decrease in support from today’s benefit. Those coverage losses are deeply concerning.

We were also troubled to see our longstanding Medicaid structure get swept up into the debate around health care reform. This has a huge impact on kids because children without disabilities are the largest group of enrollees in Idaho’s Medicaid program, followed by children with disabilities. Idaho Medicaid provides early developmental screenings, dental care, and other vital medical services that low-income children might not otherwise receive. The AHCA puts medical treatment for kids at risk.

There’s also a fiscal risk to our state. Idaho Medicaid is lean and efficient with costs growing much more slowly than private health insurance. Since Medicaid was enacted decades ago, Idaho has been able to weave matching federal funds together with our state investment. This risk-sharing works well and provides incentives that effectively control costs.

The AHCA would put a cap on the current Medicaid program, which shifts the risk of any unexpected cost growth completely to our state’s general fund. That’s the same revenue source that funds schools, higher education and public safety.

As the Republican Gov. Doug Ducey of Arizona wrote to congressional leaders, this change to Medicaid financing “will result in the single largest transfer of risk ever from the federal government to the states.”

We are ready to embrace change to improve our health care system. Unfortunately, the AHCA creates new problems and brings enormous risks to our kids, our families and our state.