The Coalition to Stop Overdose led a letter signed by 469 organizations expressing serious concerns with several of the health system reform included in the Graham-Cassidy-Heller-Johnson (GCHJ) proposal. The letter highlights how GCHJ’s proposed changes to our health care system would result in reductions in health care coverage, particularly for individuals with substance use disorders and mental illness.
In the face of the opioid overdose and suicide epidemics, equitable access to a full continuum of mental health and substance use disorder treatment services, including medications to treat substance use disorders and mental illness, must be an essential component of health care coverage. It is also critical that substance use disorders and mental illness be covered on par with other medical conditions consistent with the Mental Health Parity and Addiction Equity Act (MHPAEA).
GCHJ would require coverage of mental health and substance use disorder treatment consistent with MHPAEA as part of the new Medicaid Flexibility Program. However, the letter emphasizes how many of the other changes to the health care system in the proposal that would result in reduced access to substance use disorder and mental health treatment, including changes that would cap federal funding for Medicaid, end the Medicaid expansion, and eliminate mental health and substance use disorder benefit protections for Americans insured through the small group and individual markets. In addition, there are provisions in the proposal that would allow states to easily waive Essential Health Benefit requirements, end Medicaid expansion and change Medicaid to a per-capita or block grant financing system.
The Medicaid expansion in particular has led to significant increases in coverage and treatment access for persons with substance use disorders and mental illness. In states that expanded Medicaid, the share of people with substance use disorders or mental illness who were hospitalized but uninsured fell from about 20 percent in 2013 to 5 percent by mid-2015, and Medicaid expansion has been associated with an 18.3 percent reduction in the unmet need for substance use disorder treatment services among low-income adults.