Local mental health services would decline if ACA repealed

Published 4:55 am Wednesday, March 22, 2017

There are options in Wallowa County for those in need of mental health services, but those options would dwindle if the Affordable Care Act is repealed by Congress.

Should ACA be repealed, more than 400 individuals in Wallowa County who are enrolled in mental health services could lose access to treatment and care, said Chantay Jett, executive director for the Wallowa Valley Center for Wellness.

Although there are several residential treatment programs in the county, the majority of Wallowa County individuals dealing mental illness are in outpatient treatment. Many deal with anxiety, depression and substance abuse and remain in the community.

While the Affordable Care Act improved access to mental health care for many suffering from mental health issues and addictions, health care options for outpatient treatment was especially improved.

Prior to the ACA, individuals with mental health issues could be denied insurance coverage for a variety of reasons, including pre-existing conditions. Children, diagnosed at a young age, could be dropped from their plan at any time if their insurer ruled they had a pre-existing condition.

And for adults dealing with mental health issues, finding employment can be difficult or impossible, so many were unable to obtain reliable private insurance through their employer.

Wrap around care

After the ACA came into effect, these men, women and children not only had guaranteed coverage for medication and therapy but also for rehabilitative services.

These wraparound services, along with the “braiding” of funding to provide comprehensive care, is possibly the most important benefit to mental health in the ACA said Kevin Campbell, CEO of Greater Oregon Behavioral Health, Inc. (GOBHI).

This continuum of care includes school-based counseling, mobile crisis services, supported employment, community treatment, mental health prevention and promotion as well as outpatient treatment for children, families and adults, including case management and peer delivered services, substance use disorder treatments, gambling treatments, and on-site primary care.

“As Congress considers significant reforms to health insurance coverage, it is critical that such reforms do not undo the gains and progress we have made,” said Jett.

The progress has been felt by millions of Americans.

The American Psychiatric Association reports that 68 million Americans suffer from mental illness or substance addictions. And according to the federal Substance Abuse and Mental Health Services Administration, since the establishment of ACA nearly 30 percent of those who got coverage through the nationwide Medicaid expansion were individuals suffering with a mental disorder. Those disorders can include anxiety, schizophrenia, or an addiction to substances such as opioids or alcohol.

These are among the country’s most vulnerable individuals — according to the APA — those most likely to suffer from poor mental health and addictions. They are most at risk of becoming homeless, incarcerated or committing suicide.

WRAPAROUND CARE

GOBHI CEO Kevin Campbell said that in his opinion the greatest loss, should the ACA be repealed, would be losing important parts of wraparound care. Such care, Campbell said, can dramatically improve the lives of both the mentally ill and their families.

Wraparound care provides integration and collaboration within the broader health system. This goal is to create security and access to community-based services to keep people with mental health issues out of jail or hospitals.

“This is important because early intervention saves lives and saves money,” said Jett. “As Congress considers significant reforms to health insurance coverage, it is critical that such reforms do not undo the gains and progress we have made to improve health, increase care and reduce cost — Oregon’s triple aim.”

JOBS, JOBS, JOBS

To service the increase in individuals now able to access reliable care, it was necessary to hire and train more healthcare workers

Since the ACA was implemented 23,300 new health care jobs were created in Oregon, according to the Oregon Health Authority.

Campbell reported that his group was funding more than 150 health care workers through their behavioral health provider network.

“Those jobs weren’t there three to four years ago,” Campbell said. “It’s not all about the money, it’s about the flexibility clients got in treatment. Our enrollment grew by over 60 percent. We went from 28,000 to 48,000 enrolled. “

EXPANSION

Before the Affordable Care Act, the Oregon Health Plan was directed by the legislature to offer the children’s health improvement program (or CHIP) to all Oregon children who came from a family that had an income of double twice the national poverty line.

But few adults were covered by the plan, because the income limits were so low.

“There were a whole lot of kids with coverage through OHP and their parents didn’t have that coverage,” said Campbell. But after the ACA, the income levels were increased to all adults who made 138 percent of the poverty line.

There are major benefits when an entire family is involved in treatment, something that has been done in Wallowa County for many years through Wallowa County Together. And Campbell said that work must continue for the community to see the full social benefit.

But access to mental health wrap around care is not just for the severely mentally ill, or families with addiction or other functional problems.

Campbell notes there are times when individuals need temporary emotional help, and the ability to find that in a primary care setting is important.

“Adolescence is a horribly challenging time, after having a baby is another time,” he said. “There’s nothing wrong with you if you’re having difficulties, it’s perfectly normal to be stressed at this time and being able to refer people for mental health assistance or getting someone to come in and get help — that’s the magic that I’ve seen happening. “

CUT BACKS

Even if ACA is not repealed until 2020, as Republicans are currently suggesting, the danger of cuts to services remains.

Chris Bouneff, executive director of National Alliance on Mental Illness, discussed those threats in the alliance’s February report for staff.

“We knew the day was coming that the federal investment would decrease for this “expansion population” and that Oregon’s share would increase,” he wrote. “That day is now here.”

He said there is a great danger of “going back to the days when people in need received nothing, which put untenable pressure on emergency rooms, law enforcement, schools and just about every other public agency and community setting. There is no excuse to go backward.”

“We’ve got real challenges,” said Bob Joondeph, executive director of Disability Rights Oregon.

“Oregon does not stack up well in terms of youth illicit drug use, youth suicide rates, the number of adults receiving mental health care. We know statistically we’re a long way from filling the need. People’s health can be improved if there is good preventative health assistance available. But it requires a new way of building a capacity to deliver that assistance. Frankly the way the world works is that is driven by money. Everyone recognizes it is good for people’s health, but finding the money . . . Squeezing down access to resources is not going to do it.”

The Republican plan

The Chieftain has attempted to contact a number of policymakers and legislators to get an explanation of how the Republican-proposed American Health Care Act effects the mentally ill, but the act being debated in the U.S. House of Representatives is still in flux and hard answers are nil.

Eric Fruits, an economics professor at Portland University and economy advisor for the Cascade Policy Institute, a right wing think tank, expressed the feelings of most individuals involved in the process.

“I think what you see today is nothing like what we’ll actually end up getting,” he said. “Who knows where it will go?”

He did, however, speak to the biggest problems Republicans had with the Affordable Care Act.

“There is a huge chunk of the middle class that has been hammered hard by ACA, seeing huge decreases in the value of their coverage,” he said. “The middle class is worse off under the ACA than pre-ACA. Also, employer insurance has dropped 2 percent.”

Fruits believes that free market health insurance will benefit the public, because under the ACA insurance companies were mandated to provide a level of coverage that were not needed by many healthy people.

For instance, Fruits said a woman past child-bearing age does not need pregnancy services. Some older individuals do not want “extraordinary measures” to be taken should they have a heart attack or stroke, and may have advance directives stating the limits of care described.

“I think if we had insurance that was not so saturated with mandated benefits you might find you can afford it,” Fruits said.

Fruits said he did not know how the Republican proposal would effect the mentally ill, but he thinks its an important part of the nation’s health care system.

“I am becoming more and more convinced that substance abuse disorder is a physical and mental issue that should but addressed in our health care system,” he said. “There are treatments that work. Some of the more effective treatments require medical intervention.”

The primary problem, according to Fruits, is economics.

“I’ve said that the state of Oregon can’t afford the Medicaid expansion as it’s written,” he said. “Oregon committed to this Medicaid expansion and knew the federal aid will be dialed back and never made any plans for that. People are correctly worried that if the Medicaid expansion is dialed back, a lot of people will lose coverage.”

According to the National Council for Behavioral Health, the rollback of expanded care would end coverage for approximately 1.2 million Americans with serious mental illness or addiction problems.

Nearly all of the country’s largest mental health groups have lined up against the legislation in its current form. The Mental Health Liaison Group, a group of more than 60 national organizations, wrote a letter expressing “serious concern” about the new act and urging legislators to “continue to protect vulnerable Americans’ access to vital mental health and substance use disorder care.”

And Oregon’s poor and rural residents and those who are too young to qualify for Medicare, would lose the most under the Republican proposal, according to data compiled by the Kaiser Family Foundation and analyzed by the Lund Report.

That report analyzed residents of Wallowa County and found that 60 year olds with an income of $20,000 would lose $9,760 in tax credits; those with an income of $30,000 would lose $8,230; those with an income of $40,000 would lose $6,640. But those with incomes of $75,000 and more would see a reduced tax burden.

A popular feature of the plan for many businesses is that it will end the requirement for employers of more than 20 individuals to offer coverage to full-time employees.

The National Federation of Small Businesses came out in favor of the business considerations of the Republican proposal.

Other features of the new act, as proposed, include removing tax penalties for those who choose to go without health insurance. Insurers would also be allowed to increase premiums by 30 percent for clients who let their coverage lapse and then seek to reinstate. In addition, federal funds will be cut to Planned Parenthood clinics for one year.

Some things will remain the same.

Republican legislators say they will keep the prohibition on denying coverage to people with pre-existing conditions, ban lifetime coverage caps and continue to allow young people to remain on their parents health plans until age 26.

“There is no excuse to go backward.” Chris Bouneff, executive director of National Alliance on Mental Illness