By now, the Congressional Budget Office’s assessment of the proposed American Health Care Act’s impact on health coverage in the US is well-known. The Republican plan to repeal and replace the Affordable Care Act is projected to leave 14 million fewer Americans with health insurance after its first year, a number that rises to 24 million after 10 years.
Much of that reduction in coverage would come because of poor seniors being priced out of the market by extraordinary increases in the cost of coverage. According to CBO, a 64-year-old with earnings equal to 175 percent of the federal poverty line would see their net annual premium costs after tax credits rise from $1,700 per year to $14,600 per year, a 759 percent increase.
Less well understood, though, is the impact the law would have on some of the country’s most vulnerable individuals: Medicaid recipients with mental illness, addiction problems, and even dementia.
Despite Republicans’ near constant claim that Obamacare recipients have coverage but no ability to access care because of high deductibles, the Affordable Care Act made not just coverage, but actual care, available to millions of people through the expansion of the Medicaid program. Among other things, the law mandated that state Medicaid programs, in exchange for a massive inflow of federal funds, cover mental health and addiction services.
Under the AHCA, that requirement would go away, and according to experts like Kenneth Davis, a doctor who also serves as CEO of New York City’s Mount Sinai Hospital, even people in states that continue to cover those services will face new hurdles to getting and maintaining coverage.
“Twenty percent of people on Medicaid have psychiatric illness, addiction, or dementia,” Davis said in an interview on CNBC’s “Closing Bell” Monday night. “Those people are going to be asked, every six months, to prove their eligibility again.”
Under current law, he said, they are only required to demonstrate eligibility annually. While the change may seem relatively minor to most people, Davis said, it would have a profound impact on people with diminished or impaired mental capacity.
“What happens inevitably to those people is that they fall through the cracks,” he said. “They can’t get it together to get all the paperwork together.”
The effect will be an increased number of people who drop out of the system, many of whom will wind up in hospital emergency rooms when they face a health crisis.
“Another thing that happens along the way is when those people are signed up again, they are retroactive for only 30 days. And what they are usually signed up by is the hospital because of the catastrophic condition that caused the to be admitted, which is often more than a 30-day stay. And in fact, the previous law gave a 90-day retroactive. So what you are going to have is a lot of people who are going to fall off the rolls of Medicaid.”
He said that the plan would have a “fairly devastating effect” on hospitals and in the end, would reduce the availability of services even to people with insurance coverage.
"You're going to see a lot of the hospitals that take care of indigent populations, large Medicaid populations, have to close,” he said. “You're going to see diminished services. You're going to see hospitals like ours, which are academic medical centers, find ways to cut other parts of our programs substantially."