CADD CORNER: The Republican’s American Health Care Act and Pre-existing Conditions

Why aren’t we also talking about threats to mental health care?

By Jeffrey L. Edleson

May is Mental Health Awareness Month but reading the news of late you wouldn’t know it. It has felt more like Pre-Existing Condition Month.

The great public discussion of the American Health Care Act (AHCA), as recently passed by the Republican-controlled U.S. House of Representatives, has focused on the Act’s undermining of a provision to provide health insurance to anyone regardless of pre-existing conditions. It doesn’t appear to name experiences like rape, domestic violence or pregnancy as pre-existing conditions, but will permit states to get waivers to consider these factors when individuals apply for insurance.

As someone who has devoted my career to preventing domestic violence, I can tell you that in the 1990s denial of health care to women who had been victims of domestic violence was common and, as recently as 2009, Politifacts estimated six to eight states still permitted denying women health insurance based on prior domestic violence victimization.  The Affordable Care Act (aka Obamacare) outlawed this possibility beginning in 2014.

In early May 2017, as reported by multiple news outlets, a reporter was even arrested in West Virginia for persisting in asking Secretary of Health and Human Service Tom Price if domestic violence could be considered a pre-existing condition under the House-passed AHCA. Price refused to answer the reporter’s question, but it is clear that states could opt-out of providing insurance or charging more to formerly battered women under the proposed AHCA legislation.

What About Mental Health Care?

As someone who has worked with victim/survivors of domestic violence, their children and the partners who beat them, I can tell you that mental health care is an integral part of ending domestic violence and healing the wounds of survivors and their children.

Provisions in the House-passed AHCA could greatly undermine the recent expansion of mental health care to previously uninsured Americans. I’m surprised this hasn’t become as significant of an issue as pre-existing conditions.

Mental health parity was passed into law in 2008. It was a bill championed earlier by the late Paul Wellstone, Senator of Minnesota, among others. The bill, titled the Mental Health Parity and Addiction Equity Act, prevented insurance plans from offering benefits for mental health care that were less than those for physical or medical care, as was common at the time of its passage. Obamacare then added mental health care, among others, as a basic required benefit of any health care insurance program.

Under Obamacare, health insurance coverage—and with it mental health care coverage— expanded to almost 20 million Americans, according to a report issued late last year by the Robert Wood Johnson Foundation and the Urban Institute (Garrett & Gangopadhyaya, 2016). The report also states that California’s uninsured fell by more than half, translating into 3.8 million more people insured in our state.

Unfortunately, under the new AHCA states can opt-out of requiring insurance plans to include mental health care, among other provisions. In addition, mental health conditions could once again be considered a pre-existing condition that leads to denied or higher-priced insurance. Adding insult to injury, the huge $800-billion rollback in support for Medicaid under the Republican legislation will leave many poor without any insurance.

The Congressional Budget Office’s last estimate of the impact of the AHCA is that 24 million Americans could lose their health and mental health care insurance in the next decade.  We cannot let this happen! Concern for mental health care provisions of the AHCA has to be put front and center along with equally valid concerns about pre-existing conditions and the Medicaid rollback.

Jeffrey L. Edleson, Ph.D. has studied domestic violence programs for almost 40 years. He is Dean and the Harry & Riva Specht Chair in Publicly Supported Social Services at the U.C. Berkeley School of Social Welfare. He was recently elected President of the California Association of Deans and Directors of Social Work Programs (CADD) and is a Fellow of the American Academy of Social Work & Social Welfare.