By Patty Wight
More than 19,000 Mainers will lose access to mental health and drug treatment if the Affordable Care Act is repealed, according to researchers at Harvard and New York University.
At a time when drug overdose deaths are at an all time high in Maine, health care advocates say the push by Republicans in Congress to repeal the ACA with no clear replacement will make the problem even worse.
Eleven-thousand Mainers insured by marketplace plans receive mental health treatment, according to the Harvard and NYU study. Another 8,000 receive treatment for substance use disorder. Study co-author Dr. Sherry Glied of NYU points out that these are people who, prior to the ACA marketplace, largely found health insurance unavailable or unaffordable.
“If the marketplace is repealed, those people would presumably go back to where they were before the law passed, and that is uninsured,” she says.
Glied says taking away insurance coverage runs counter to efforts across the country to battle an opioid epidemic.
Malory Shaughnessy of the Alliance for Addiction and Mental Health Services in Maine sees it in more stark terms.
“We have people dying every day, and this will just increase that,” she says.
Last year, Maine saw its highest number ever for drug overdose fatalities: 286 by the end of September. That beat the record-setting number from the year before, which had 272 deaths. As the state grapples with an increasing number of deaths, Shaughnessy says treatment options aren’t keeping pace, especially for the uninsured.
“We are not giving access to treatment to all the people who currently need treatment. And yet we’re going to throw thousands more out of the system and deny them treatment,” she says.
The potential repeal of the ACA not only means the loss of insurance coverage, it also means the loss of provisions in the law that expanded access to behavioral health treatment.
Though President-elect Donald Trump says the ACA won’t be repealed without a replacement plan, Emily Brostek of Consumers for Affordable Health Care says currently, those replacements appear inadequate.
”What you see by looking at the different replacements as a whole, is we’re talking about less coverage for people. We’re talking about generally higher deductibles, and fewer benefits being covered,” she says.
And when it comes to behavioral health in particular, Glied says cost matters.
“If you have a heart attack, even if you have a really high co-insurance or deductible, you’re still going to go to the hospital. Even if you have to pay out of pocket, you’re still going to go to the hospital,” she says. “If you have depression, that’s actually going to be much more of a problem. So if you have to pay out of pocket for your depression treatment, you probably won’t go.”
Glied also points out that Congress just passed the 21st Century Cures Act, which dedicates funding to increase the infrastructure for opioid treatment. But if people can’t use that treatment because they don’t have insurance, Glied says, it does little good.