Update on the US Senate Effort to Repeal and Replace Obamacare

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CHADD Public Policy Committee

The Senate has been preparing to vote on the
Better Care Reconciliation Act (BCRA), which would repeal significant portions
of the Affordable Care Act (ACA or “Obamacare”) and replace them with
alternative policies. However, when it became apparent BCRA might not have
sufficient support among Republican senators, Senate Republican leaders began
to consider a repeal of many ACA provisions without specific replacement
policies (the Obamacare Repeal
Reconciliation Act of 2017 or
“Clean Repeal”).
Senate leaders plan to bring the legislation up
for a vote any day, although it is not clear which bill will be considered. It
is possible that amendments may be offered for BCRA, or they might fall back on
Clean Repeal, legislation that
the Republican Congress passed in late 2015, but was vetoed by then-President
Obama.
Because CHADD does not know exactly which bill
the Senate is planning to vote on, we don’t know exactly how to advise our
members. However, we can report what BCRA looks like now and how it could
affect individuals with ADHD. We can also report what the Clean Repeal bill
provides and how it could affect individuals with ADHD.

The Better Care Reconciliation Act (BCRA):

The Congressional Budget Office (CBO) has released official
estimates about the version of BRCA posted on the website of the Senate Committee on the Budget on July
20, 2017. The CBO estimate shows that BCRA would reduce the deficit by $420 billion over
ten years. CBO further estimates that BCRA will result in 15 million fewer people having health care coverage in 2018. By
2026, this number would increase to an additional 22 million Americans lacking
insurance, compared to current law.

BCRA makes a number of changes to Medicaid and private
health insurance that would, on the whole, make it harder for many families to
access ADHD treatment. Most notably, BCRA substantially cuts federal funding
for Medicaid, which is a primary payer for millions of children with ADHD. Over
time these cuts would lead to reduced benefits, decreased access to health care
providers, and would make it harder for families to access ADHD treatment. It
would also roll back the Medicaid expansion, which allows many adults to access
ADHD treatment. In the individual marketplaces (what is often called
“Obamacare”), most families would receive less assistance paying for
their insurance premiums, and the insurance they pay for would offer less
coverage. This too could substantially limit access to ADHD treatment for
millions of families across America.
BCRA could benefit some families. For example, it extends
premium subsidies to individuals below the poverty line but who do not qualify
for Medicaid and it allows families to obtain premium subsidies if a parent’s
employer provides coverage only for the parent. Proponents of the legislation
also tout its potential to reduce insurance premiums; however, these effects
are still somewhat speculative. Decreases in premiums may be caused in part by
insurance plans declining to offer certain benefits, including coverage for expensive prescription drugs, behavioral health services, and mental
health care. Although Obamacare required plans to provide coverage for
these “essential health benefits,” BCRA would make it easier for states to opt
out of providing these mandated
benefits. Recent amendments offer additional funding that may reduce premiums
for some, but the effects on coverage are uncertain.
Some of the other changes could also impact individuals with
ADHD. BCRA mandates a six month “lock-out” period for re-enrolling in
health insurance after a period of not being covered. However, the Senate
Parliamentarian has ruled this provision violates to the so-called Byrd Rule,
which means it could not be enacted without Democratic support (which is
unlikely). Individuals with ADHD who
obtain health insurance in the individual market would need to pay very close
attention to deadlines to avoid coverage lapse. Similarly, BCRA
limits the period for which Medicaid coverage can be retroactively applied when
a Medicaid eligible individual seeks treatment before enrolling in Medicaid.
BCRA is similar in many respects to the American Health Care
Act (AHCA), passed by the House of Representatives in June, and different in
other critical ways. Read CHADD’s analysis of the AHCA. Read a side-by-side comparison between BCRA, the AHCA, and existing law – especially how it
affects mental health and pre-existing conditions.

Obamacare Repeal
Reconciliation Act of 2017 (Referred to here as “Clean Repeal”):

CBO has also released official estimates about the Clean Repeal legislation
posted on the website of the Senate Committee on the Budget on July
19, 2017. The CBO estimate shows
that Clean Repeal would
reduce the deficit by $473 billion
over ten years. The CBO also estimates that Clean Repeal will result in 17 million fewer people having health care coverage in 2018. By
2026 this number would increase to about 32 million additional Americans
without coverage, compared to current law. CBO further estimates that by 2020 about half of the
U.S. population would live in areas with no insurer that offered insurance for
individual policies purchased through the marketplace or directly from
insurers; and that would increase to about three-quarters of the population by
2026. In addition, the CBO estimates the cost of average premiums for
individual policies purchased in marketplaces or directly from insurers would
increase about 25 percent more than projected under current law by 2018 and
would double by 2026.
Clean Repeal would repeal many provisions of
the ACA
or Obamacare but would retain many of its insurance rules. After Clean Repeal,
all plans sold on the individual markets, as well as Medicaid plans, would
still be required to cover
essential health benefits (EHBs), which include treatments for mental health,
behavioral health and substance use disorders. Health insurers would still not be permitted
to deny health insurance coverage or charge higher premiums based on having a “preexisting condition,” like ADHD
diagnosed before an
individual buys health insurance. These protections would continue to help
individuals with ADHD. However, the legislation would immediately repeal the
penalties for individuals who do not maintain
qualifying health insurance coverage (including coverage under government
programs like Medicaid) and for employers with 50 or more full-time employees
who do not provide qualifying health insurance to their employees. CBO
estimates that elimination of these penalties would cause premium costs in the
individual marketplace to rise for individuals, such as those with preexisting
conditions who needed to retain coverage, and could cause employers to stop
offering group plans for employees. These results could make it much more
difficult for families and individuals with ADHD to obtain insurance coverage.
Starting in 2020, the legislation will repeal Medicaid expansion which has
allowed many adults in some states to access ADHD treatment; and premium
subsidies that help individuals purchase insurance in a marketplace will also
be repealed. This could significantly limit access to ADHD treatment for
millions of families nationwide. 
*             *             *
CHADD is dedicated to protecting access to ADHD treatment
for families across America. While our members may have different views on the
repeal and replacement of Obamacare, CHADD has serious concerns that these
bills, if either were enacted, would create significant hardships for many
children and adults with ADHD. For these reasons, CHADD has been on the record
with Congress and joined organizational sign-on letters in opposition to the
legislation.

While CHADD encourages its members to do their own research
on the current proposals, we are disseminating the action alert below for those
who are interested in making their voices heard in the legislative process. The
action alert was prepared by the Mental Health Liaison Group (MHLG), a
coalition of which CHADD is a member. The Senate is expected to vote on one of
these measures this week, and as early as Tuesday.
Action Alert on Health
Reform
What are key changes in the
BCRA?
  • Allows
    insurance companies to offer bare-bones plans with no mental health
    coverage,
    as long as they offer a single plan that covers mental
    health and substance use services. This is a giant step away from parity,
    or fair coverage of mental health conditions.
  • Provides
    $45 billion in short-term grant funding to states for the opioid
    crisis.
    This is a drop in the bucket compared to the Medicaid funding
    that will be lost under the bill.
  • Provides
    a complicated “stability” fund to states. These funds don’t make up
    for cuts to Medicaid and loss of mental health coverage—and there’s no
    guarantee they’ll be spread evenly among states or will help people who
    lose or can’t afford coverage.
What’s unchanged in the BCRA?
·       
Leaves fewer Americans with coverage for mental health care;
·       
Takes away insurance protections for people with mental health conditions;
·       
Effectively ends Medicaid expansion;
·       
Cuts and caps Medicaid funding, which will make it harder for people to get medications and
mental health services; and
·       
Allows states to adopt work requirements
for people covered by Medicaid (including those with mental illness) who are
not on federal disability (SSI/SSDI);
What’s next?
Next week, the bill could come up for a vote and pass—unless 3 Republican
Senators vote NO.
What to do this weekend (and
week of 7/17):
Regardless of whether your Senators are
opposed to or supportive of the BCRA, your alerts and social media posts will
help emphasize the impact of the bill on people with mental illness.
Note: If you live in a state
with Senators who are considered moveable, please put extra effort into
reaching out (Alaska, Nevada, W. Virginia, Ohio, Louisiana, Kansas and
Arizona).
 
  1. Send an alert to your members
  2. Post on social media using
    #Act4MentalHealth
  3. Tweet directly at your Senators or post on their Facebook page

Alert and social media images

Subject
line:
This bill hurts.
Text: The Senate delayed a vote on the Better Care Reconciliation
Act (BCRA), but they are back at it—and they are moving fast. A vote could
happen any day.
They have
revised the bill and it isn’t better, it’s worse.
New language would let insurance companies offer
bare-bones plans with no mental health coverage. This is a giant step
away from parity, or fair coverage of mental health conditions.
There will still be less financial assistance
and fewer protections for people who buy individual health insurance plans
through the marketplace.
The bill still cuts and caps the Medicaid
program, which will make it harder for people to get psychiatric medications,
case management, mental health services—and even hospital care
.
Millions will still lose their Medicaid
coverage, including 1 in 10 veterans who rely on Medicaid for health and mental
health services.
The bottom line: this bill hurts people with
mental illness.
But, the fight
is not over. Together, we are powerful. Together we can #Act4MentalHealth. Tell
your Senators to vote NO on the BCRA.
The Senate has revised the Better Care Reconciliation Act
(BCRA) and it isn’t better, it’s worse. The
bottom line: this bill hurts people with mental illness.
But, the fight is not over. Together, we are powerful.
Together we can #Act4MentalHealth. Tell your Senators to vote NO on the BCRA.

http://ow.ly/wMIB30dEgF6 
Oppose any bill that leaves fewer
people with mental health care. Together, we must #Act4MentalHealth
http://ow.ly/wMIB30dEgF6
We know
that the toughest fights are worth it. Tell your Senators no on #BCRA!
http://ow.ly/wMIB30dEgF6 #Act4MentalHealth 
The
Senate health reform bill hurts people with mental illness. Tell your Senators:
Vote NO.
http://ow.ly/wMIB30dEgF6 #Act4MentalHealth

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