The American health care system has been taken hostage. The right and the left spin potential policy fixes to score partisan points and win news cycles. And lost in the petty squabbling are the flesh and blood Americans.
One in five Americans suffers from a mental illness. They face an uncertain future while stuck in a disappointing present, wondering if the House of Representatives’ American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA) holds the key to finally decreasing the number of people who report an unmet need for mental health services — a number that hasn’t changed since 2012.
2008 saw the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) which mandated that insurance plans couldn’t cover mental health treatment differently than they covered physical health treatment. This law eliminated annual and lifetime caps on treatment as well as burdensome co-pays and increased deductibles. In 2010, the Patient Protection and Affordable Care Act (ACA) made substance abuse and mental health treatment one of the Ten Essential Health Benefits that health care plans must cover. By itself, the MHPAEA only ensured equal treatment under plans that included mental health coverage in the first place. Before the ACA was passed, the MHPAEA was largely symbolic and left scores of Americans without mental health coverage. Together, these two bills expanded access to and increased the quality of mental health coverage.
Unfortunately, nearly 60 percent of Americans with a mental illness still don’t receive treatment even after the passage of these two bills. The ACA and the MHPAEA were a step forward for mental health treatment in the United States, but Americans still face daunting barriers to receiving the care they need.
The Better Care Reconciliation Act (BCRA) currently under debate in the Senate prioritizes paying back the federal government’s involvement in the health insurance market. The BCRA would allow states to define “Essential Health Benefits” for themselves, a move its supporters believe will allow states to provide more effective, tailored health care. Additionally, the BCRA would transform federal Medicaid spending from a matching program, where the federal government matches any funds that a state spends on Medicaid, to a per-capita grant through which states receive a certain amount of money, linked to the inflation rate, for every Medicaid enrollee. Additionally, to combat the 25 percent premium increase marketplace plans are seeing across the country in 2017, the AHCA would group customers with pre-existing conditions into subsidized high-risk pools, removing the most expensive Americans from the general market, thereby lowering premiums for the majority of Americans. The BCRA would keep in place ACA protections for people with pre-existing conditions.
How should Christians evaluate these two bills? Clarke Cochran wrote in his piece for Public Justice Review that America’s fierce individualism shouldn’t extend to health care — a community endeavor that strives to advance the common good. Community endeavors only succeed when divisions are bridged. Health care reform can only succeed when the gap between mental health and “regular” health is bridged.
Unfortunately, mental health is isolated from physical health and has been tagged with a stigma. Individuals who suffer from a mental illness are seen as dangerous and abnormal, and mental health has become a taboo topic. Mental health treatment must be culturally integrated into “standard” health care so that mental health as a political issue can be brought into the spotlight.
Mental health is often wrongly treated as an afterthought by insurers, elected officials, and even medical professionals. It is regarded as a secondary, niche concern that needs to be accommodated by a specific measure. This fragmentation began after President Kennedy started de-institutionalizing state-run asylums. The mainstream health care system became responsible for these patient’s care, which required creating special carve-outs in insurance plans and specialty in- and out-patient mental health facilities. If this transition had been handled correctly, patients who suffer from mental illness would have been integrated into the mainstream health system, and a mental illness like depression would be seen as a medical condition the same way a broken arm or the flu is.
Any reform or policy that plays into the stigma of a mentally ill person as strange or dangerous must be altered. Does the AHCA or the BCRA further stigmatize mental health by continuing to isolate it from “mainstream” or “normal” health care? Or does it take steps to integrate mental health treatment into traditional health care conversations?
Separating mental health and physical health is partly a consequence of western philosophy that views the mind and the body as connected, but inherently separate from one another. The national health care reform conversation has to transcend this constructed, theoretical barrier and move mental health considerations from the back burner to the front of the conversation. Failing to do so will lead to higher overall health care costs — physical conditions are twice as expensive to treat if the patient also suffers from a mental illness — as well as the further marginalization of Americans who need every bit of help they can get to flourish the way God intends them to.
Experts say that the Senate bill, the BCRA, would reduce federal Medicaid spending by nearly $800 billion, forcing to states to search hard for any opportunity to shrink their budgets. Programs that champion integrated health care, a treatment model that places behavioral health specialists in primary care settings and are most often state-designed innovations funded by Medicaid waivers, would be among the first impacted by funding cuts. Additionally, states that choose to opt out of the Essential Health Benefits would no longer require all insurance plans to cover mental health treatment, which would further push mental health issues into the shadows, as well as make it harder to access treatment for those who do have coverage. Finally, the AHCA will make it legal for insurance companies to increase prices if someone goes without coverage for 63 days, a measure that seems to go against the ACA’s prohibition on discriminating against people with pre-existing conditions. Most mental illnesses manifest in a person’s late teens or early 20’s, which would mark them with a pre-existing condition for the majority of their insured lives. Even though the BCRA would keep that protection in place, insurance plans could simply refuse to cover expensive medical treatments — another form of discrimination.
If the AHCA and BCRA will not improve the United States mental health system, then what should be done? Just as Christ embraced the cast-offs and marginalized in his day, Christians must advocate for more robust mental health care – care that de-stigmatizes mental health issues.
The most effective way to fight stigma is to understand what mental illnesses are: a set of diseases with physiological, and biochemical causes that can be managed like any other chronic illness. Stereotypes and stigma come from a lack of interaction, so Christians need to lead the way in integrating people with a mental illness into their congregations and communities. Only by sitting and talking with someone who suffers from depression, breaking bread with someone being treated for schizophrenia or bipolar disorder, or giving a someone struggling with a heroin addiction a ride to the methadone clinic can we begin to understand the depth of their pain, and the reality of what cultural stereotypes and stigmas do to their chances of healing. In the church itself, members who suffer from a mental illness should be treated the same as someone suffering from cancer. Mental illness cannot be chalked up to an insufficient prayer life or a dearth of character. Christians and the institutions they comprise, whether colleges, mental health advocacy groups, or neighborhood block associations, have to use the resources and tools God has blessed them with to advocate for accessible, efficient, and just health care policies.
-Matt Leistra is a recent political science and journalism grad from Calvin College where he was a staff writer for the Calvin College Chimes. He is currently a freelance writer focusing on health care and mental health policy.