Repealing and Replacing The Affordable Care Act: What We Stand to Lose

First, welcome to our new behavioral health and wellness blog.  

We hadn’t planned it this way, but it’s fortuitious that our blog is going live at this critical juncture in the future of American healthcare—particularly for low and middle-income families and individuals.

On Monday, March 6, the U.S. House Republicans unveiled its long-awaited plan to repeal and replace the Affordable Care Act (ACA).

The legislative efforts to repeal and replace the ACA—including or especially a potential rollback of the Act’s Medicaid expansion—carry special risks for men, women and families struggling with addiction and mental health disorders.

Of course, this is not the only patient sub-group who stands to lose here, but these are the folks who we, at Lahey Health Behavioral Services, are privileged to serve. Our clients’ health and recovery are what inspire us all to go to work every day. 

Or, as Linda Rosenberg, president and CEO, National Council for Behavioral Health writes, “Medicaid is not a partisan issue; it is a human issue.”

What’s at Risk Here?

Last year, the U.S. surgeon general’s report confirmed what we have suspected and feared: 21st-century America has an epidemic substance use problem. Substance use disorders affect 20.8 million Americans-more than 1.5 times the annual prevalence of all the cancers combined. 

Closer to home, Massachusetts’ opioid-related deaths are higher than the national average with an alarming spike in fatalities over the past two years. In 2014, fatal overdose rates in Massachusetts more than doubled the rate in other U.S. states.

The good news: As you read this, 1.29 million Americans are in treatment for substance use disorders or mental illnesses. These include 220,000 people who are now being treated for opioid use and who stand to lose coverage and, by extension, access to treatment and care.

“Medicaid is not a partisan issue; it is a human issue.”

First, the Facts

The Affordable Care Act is a complicated set of healthcare legislation. We have provided some resources (below). 

In upcoming blog posts, we will present stories from the field—the real-life opinions and voices that put a face with the statistics. Stay tuned.

Meanwhile, here are some key facts about mental health and addiction coverage and access:

Medicaid expansion increases access to treatment: Approximately 29% of persons who receive health insurance coverage through the Medicaid expansion (a key component of the Affordable Care Act) either have a mental disorder (e.g. schizophrenia, bipolar disorder, clinical depression, anxiety) or a substance use disorder (e.g., alcoholism, opioid addiction) or both.

Medicaid expansion and our opioid epidemic: Today, more Americans are dying of drug overdoses than from car accidents.  By covering low-income childless adults up to 138 percent of the federal poverty line, the Medicaid expansion enabled 1.29 million low-income people with substance use disorders or mental illness to gain access to coverage that is unavailable to their peers in non-expansion states. Medications such as Vivitrol, Soboxone, Burprenorphine and the overdose reversal drug Naloxone are important tools in combatting the opioid epidemic.  Today, Medicaid pays for between 35-50% of all medication-assisted treatment for addiction. 

Medicaid expansion stands to reduce U.S. healthcare spending:   Many or most patients or clients with a mental health condition have a second (or third) physical health condition.  Nationwide, 70% of behavioral health patients have one co-occurring chronic physical health condition such as diabetes or hypertension. Forty-five percent have two chronic health conditions, while 30% have three chronic health conditions—plus their addiction and/or mental health diagnosis.

By treating our patients’ mental health and/or addiction disorders—ideally in a fully integrated care system—we can improve their overall health and life expectancy. In turn, we can reduce the number of times these patients use expensive inpatient or emergency-room care.  In Medicaid expansion states, the share of substance use or mental health disorder hospitalizations involving patients without insurance fell from about 20% at the end of 2013 to about 5% by mid-2015.

3 Ways to Help and Advocate

1. Educate Congress: Write a letter or make a call to your local representatives. Don’t know who your local state representatives or U.S. senators are? The Massachusetts Association for Behavioral Healthcare’s website can help. Simply log in your town and zip code for a full list of your local public representatives and how to contact them. 

Also, the National Council for Behavioral Healthcare has launched Unite4BH, your one-stop guide and informational advoacy resource

Join #Unite4BH on social media and sign up for Twitter chats.

2. Write an Op-Ed or a letter to the editor:  Your Op-Ed will be particularly effective if you co-author with someone who has a different local role or perspective than yours. For example, if your family member has a mental health diagnosis and is scared of losing her insurance coverage, partner with a healthcare provider or a member of your local law enforcement. Together, you can write an Op-Ed or letter than gives another perspective from another concerned person.  Every newspaper or digital media publication has its own submission guidelines and required word count. But generally speaking, 600-800 words are ideal for an OpEd, while approximately 200 words work for a letter to the editor.  For more info on how to pen an Op-Ed, click here.

3. Tell your own or your family’s story:  The Facebook page, “Humans of New York” has almost 18 million followers. Why? Because stories, not statistics, engage people.  Stories, not statistics, build empathy. Stories, not statistics, give a face to the issues and the very real and imminent risks inherent in the repeal and replacement of the Affordable Care Act. In the next few weeks, we are excited to start sharing ours.

Storytelling tips: Tell your story via simple, conversational language and always get permission before you tell a family member’s story—and make sure that your loved one knows exactly where and why you’re doing this.  For examples of well-curated and told stories, check out the Massachusetts State Without Stigma project and its gallery of first-person stories from the frontlines of addiction and recovery.  Your story doesn’t have to be long. It simply needs to highlight how expanded for first-time access to healthcare coverage has impacted your own or your family’s life. 


Resources and Articles on the Proposed Changes to the Affordable Care Act  

1)An estimated 300,000 Massachusetts residents stand to lose MassHealth coverage under the proposed new health plan


2) Unpacking the Administration’s Market Stabilization Proposed Rules, by Timothy Jost


3) Families USA—President Trump’s Proposed ACA Changes Favor Changes Favor Insurers at Consumers’ Expense


4) Today in Obamacare: Trump’s big new Obmacare regulation, explained, by Sarah Kliff




< ACA Repeal: Stories from the Frontlines of Mental Health Treatment and Care  |  

Reporters, health bloggers, producers:

Types of stories and commentary: Mental health, teenage wellness (bullying, suicide, drug use, depression), family health, domestic abuse, sexual assault, drug use, alcoholism and related or proposed state and federal legislation.

Timelines: Usually, we have been able to set a reporter up with an expert interview within 24 hours (or less) of the initial call. While we are often restricted by federal HIPAA laws, we will make every effort to help you to tell your story, meet your deadline and to put a human face on the issues.

Beat: Our programs serve towns and cities in Essex County, the Merrimack Valley and Greater Boston.

Contact: Call us at 978-968-1736 or email us. Check out some recent stories (left), or follow our news ideas on Twitter.