Since the Senate healthcare reform bill was released late last week, there's been tons of conversation around what's in the darn thing. Among the rotten provisions in the current iteration of Trumpcare — and there are many — arguably the least discussed are those affecting individuals with mental illness.
Mental illness is an extraordinarily broad category, by the way; it includes everything from anxiety, depression, bipolar disorder, eating disorders, ADHD, schizophrenia and more. To escape the bill's clinical, impersonal language and get to the point: Folks living with mental illness are about to get completely screwed.
One in five Americans suffers from mental illness, and Medicaid is the single largest payer of their mental health services. Under the Affordable Care Act's Medicaid expansion, an estimated 1.3 million Americans with mental illness gained health insurance for the first time. The House and the Senate versions of Trumpcare would both phase out funding for that expansion and cut Medicaid spending by almost a trillion dollars over a decade, analysts predict.
Mental health coverage in the private market is also at risk. The Senate bill allows states to waive coverage for "essential health benefits," including mental healthcare — so even though you technically have health insurance, it won't actually cover the care you need. Earlier this week, GOP legislators added a provision to the bill saying that if you go without coverage for more than 63 days, you have to wait six months before getting coverage again. If Americans living with mental illness don't find a way to maintain their coverage uninterrupted, they can be locked out of new policies when they're in crisis.
It's not as if the American public — wary of rising insurance premiums — is demanding reductions in mental health coverage. The silver lining of our preponderance of mental illness is that almost everyone knows someone affected. In this case, familiarity breeds not contempt, but nonpartisan compassion; 77% of Americans believe private health insurance should cover mental health, and 51% believe all types of insurance should cover mental illness.
Stripping Americans of their mental health coverage couldn't happen at a worse time. In February, Congress repealed a rule that would have blocked gun sales to the severely mentally ill — those deemed mentally incapable of managing their financial affairs. Not all who commit violence suffer from mental illness of course, and not all who suffer from mental illness commit violence. But by depleting Americans' access to mental health treatment, Republicans make it ever more likely that those who are living with severe mental illness and who are prone to violence won't get the help they need. Meanwhile, they will have unfettered access to firearms.
Remember that not all violence is outwardly directed. Untreated mental health issues are one of the most frequent causes of suicide. Between 1999 and 2014, the suicide rate increased by 24%, making it one of the 10 leading causes of death for Americans, and the second leading cause of death among those ages 10 to 24. Of those who die by suicide, more than 90% have a diagnosable mental disorder.
And many other Americans living with mental illness will neither commit physical violence against others nor die by suicide. They will simply suffer. It's emotional violence to make someone live in a brain that is betraying them when effective treatment is available. Between 70% and 90% of individuals who have access to medication and/or counseling treatments for mental health issues see a significant reduction in symptoms. Those appointments are too hard to get and too expensive right now; they stand to get infinitesimally worse under the GOP healthcare plan.
Young Americans are suffering from anxiety, depression and other mental illnesses at unprecedented levels. Nearly 10 years ago, Psychology Today reported that "the average high school kid today has the same level of anxiety as the average psychiatric patient in the early 1950s."
Millennials and Gen Xers report far higher rates of stress than Baby Boomers and the Greatest Generation do. And it's getting worse for Americans of all ages. In February, 57% of Americans said the current political climate was a very or somewhat significant source of stress.
We need not just to maintain, but to expand our mental health treatment.
If Trumpcare goes into effect, your only safe options are to either be rich or maintain physical and mental health throughout the course of your life. Mental illness is often a lifelong, reoccurring issue; it hits without warning and can come in waves. This bill is cruel to its core, and that's a feature not a bug; the president himself called the House version "mean," but he still threw a party for its passage in the White House Rose Garden.
The argument for access to mental healthcare is a moral one; "the pursuit of happiness" should not be accessible only to the wealthy and the well. Americans living with mental illness deserve a far better bill.