Over the past fortnight, many people have come forth to national and local news outlets, social media, and personally to reveal emphatically that the Affordable Care Act (ACA) saved their lives. These first person accounts are always compelling and very emotionally wrenching. They also are playing a very important role in forming public opinion about the dramatic inadequacies of the House GOP American Health Care Act, now called "Trumpcare."
All of this has raised very important questions about the early death of persons with mental health, substance use, and intellectual development and disability conditions.
To provide context, the current overall national death rate for all Americans is 824 deaths per 100,000 population (824 deaths/100,000) per year, with a total of about 2.6 million deaths annually. If we examine the groups of great concern to us, the parallel death rates are:
Deaths Due to Heart Attack or Stroke for Adults with a Serious Mental Illness:
- 1,980 deaths/100,000 2.4 times the U.S. average
Deaths Due to Suicide for Persons Who Attempt Suicide:
- 4,000 deaths/100,000 4.9 times the U.S. average
Deaths Due to a Prescription or Nonprescription Opioid for Persons with an Opioid Use Disorder:
- 1,742 deaths /100,000 2.1 times the U.S. average
Deaths Due to Any Cause for Persons with an ID/DD Disorder:
- 860 deaths /100,000 1.1 times the U.S. average
All of these rates exceed the U.S. average, most shockingly so. (For those who would inquire, these are crude rates; they have not been adjusted for age, sex, race or any other characteristic.)
We know factually that virtually all of these groups have benefitted from the ACA. Most have been able to enroll in health insurance through Medicaid Expansion (31 states and D.C.) or traditional Medicaid. Specifically, we estimate that up to 3 million adults with a serious mental illness have enrolled in the Medicaid Expansion, and that approximately 1 million persons with ID/DD have enrolled in Medicaid, principally through Home and Community Based Service Waivers.
Further, the Medicaid Expansion and the state Health Insurance Marketplaces have provided the preponderance of health insurance coverage for persons with an opioid use disorder. Prior to the ACA, most of these persons were without any health insurance, and the only source of care funding was through the SAMHSA Substance Abuse Prevention and Treatment Block Grant. Today, we estimate that approximately 2 million persons with a substance use disorder now have health insurance coverage through the Medicaid Expansion, and more than 1 million more under the state Health Insurance Marketplaces.
Similarly, the ACA Essential Health Benefit combined with SAMHSA grant funding have made available prevention and treatment services for many persons who are at risk for suicide who previously would not have had access to these services.
The proposed American Health Insurance Act would destroy the progress that has been achieved through the ACA. The nonpartisan Congressional Budget Office estimated just a few days ago that 14 million persons would lose their health insurance in the first year, and 24 million would lose it by 2026. Richard Frank and Sherry Glied also estimated recently that 1.3 million persons with serious mental illness and 2.8 million persons with substance use disorders, including 220,000 persons with opioid disorders, would lose their insurance under this proposal.
In an earlier commentary, I outlined the devastating features of the American Health Care Act and their potential consequences for the behavioral health and ID/DD fields (See this post). These do not need to be repeated here.
Quite unfortunately, national statistics are not available to show how many lives were saved in our four core groups due to implementation of the ACA. However, because each of these groups has an exceptionally high mortality rate, it is eminently reasonable to conclude that many, many of their lives were saved due to the health insurance coverage and access to good care provided through the ACA.
With the American Health Insurance Act, these mortality rates likely would skyrocket. Therefore, it is really essential for you to contact your Representative and your Senators today and demand that they actively oppose the American Health Insurance Act. It will be exceptionally bad for all Americans.
This request is most urgent. The House is likely to vote on this bill next week.