Earlier this week, the U.S. Senate approved — by the narrowest of margins — a motion to proceed with debate on repealing the Affordable Care Act (ACA), or ObamaCare. The deciding vote on the motion to proceed was cast by Vice President Mike Pence.
After two failed attempts to pass amendments, the next likely vote will be on a “skinny bill,” a stripped-down bill drafted as a vehicle by the Senate to move forward with health reform. If the skinny bill passes, the next step will be a conference committee with House Republicans to draft a final bill for an up or down vote.
{mosads}Although the specifics of the final bill remain unclear, the distinct possibility exists that the bill will include significant cuts to Medicaid, the most important source of payment for people with disabilities, including mental illnesses. Indeed, Vice President Pence several weeks ago made a direct plea to you to support massive cuts to Medicaid in an ObamaCare repeal bill, saying “As Medicaid grows, there’s less and less money for schools, for roads and for public safety.”
At this very same meeting, you were presented with the results of a study showing that the Senate’s bill would result in reductions in federal Medicaid spending to states that range from 27 percent to 39 percent by 2036.
As you evaluate the critical choice before the Senate, I urge you to consider the impact not only to your state’s health care system and your vulnerable citizens, but the impact to mental health care and in turn, to those who have sworn to protect and serve your constituents as local and state law enforcement officers.
Recently, more than a dozen police unions nationwide, including those in Los Angeles, New York, Chicago and San Jose, called on the federal government to provide more resources, including training and partnerships with mental health professionals, to help local law enforcement agencies respond effectively to emergency and crisis calls involving people with mental illness and substance use disorders.
Throughout the country, police and other law enforcement professionals are front line responders to people in crisis, often because these individuals do not have access to needed mental health care. Medicaid cuts of the magnitude in proposals to date will only worsen this crisis – and the burdens faced by our nation’s law enforcement and criminal justice professionals.
The public would be shocked if they knew how much time and money law enforcement agencies spend in responding to mental health crises. Training officers on crisis de-escalation will help, but no amount of training will solve the problem if mental health and addictions treatment aren’t available. Yet that inevitably will be the consequence if billions of dollars in Medicaid cuts that have been proposed are passed.
Cutting Medicaid will push more people with untreated mental illness into emergency rooms, homelessness and jails. When in jail, people with mental illness stay almost twice as long as others facing similar charges. The costs to local communities and to our law enforcement professionals are prohibitive.
Medicaid is the single largest payer of mental health and addiction treatment services in the country, paying 25 percent of all mental health and 20 percent of all addiction care. Moreover, Medicaid pays for more than just medical treatment and medications. It also pays in many states for rehabilitative services that are crucial in helping people with mental illness and substance use disorders recover, maintain stability, and become contributing members of society.
In 2016, Congress passed two bipartisan bills designed to improve treatment for mental illness and for opioids respectively. After passage of the 21st Century Cures Act, which incorporated provisions from Representative Tim Murphy’s “Helping Families in Mental Health Crisis Act,” Congressman Murphy expressed his gratitude for what he called “a landmark moment.” “The federal government’s course in addressing mental health and illness in America is being fundamentally changed,” Representative Murphy stated. “Congress has finally come together in a bipartisan effort to bring serious mental illness out of the shadows.”
It is unfathomable that less than one year later, Congress may pass a bill that would not only negate any progress resulting from those bills but would decimate the most important source of funding to treat these conditions. In the long run, cutting federal funding of Medicaid will shift burdens to states and to local communities, many of whom are already struggling to address the needs of those falling through the safety net.
It is not too late to prevent this from happening, but your voice is needed this week. As the Senate considers the bill, remind them that voting for the “skinny bill” could set the stage for devastating cuts to Medicaid. Urge them to strongly consider the negative impact that this bill will have on public safety and the economic well-being of your state.
The voice of every governor must be heard to ensure that the best interests of states and communities are front and center in this debate. As a nation, we cannot afford the price we would pay if this bill passes.
Ron Honberg, J.D., serves as Senior Policy Advisor at the National Alliance on Mental Illness (NAMI) overseeing NAMI’s federal advocacy agenda and NAMI’s work on legal and criminal justice issues.
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