Mental Health Patients Worry They Won’t Survive Paul Ryan’s War On Medicaid

President Donald Trump indicated in hisfirst federal budgetthat his administration is committed to investing in programs that tackle mental illness, but the health care legislation he and Republican lawmakers are championing suggests otherwise.

House Republicans released the American Health Care Act earlier this month. It proposes slashing$880 billion to Medicaid, which is the largest payer of mental health services in the country, as well as removing the requirement that Medicaid plans cover mental health and phasing out the programs expansion under theAffordable Care Act. Health and Human Services Secretary Tom Pricehas previously advocated for reducingfederal funding of the program, too.

House Speaker Paul Ryan, the architect of AHCA, gushed this week about potentially cutting Medicaid funding.

Weve been dreaming of this since you and I were drinking out of a keg, he said to National Review editor Rich Lowry at a conferenced hosted by the publication.

There are a lot of people who have chronic mental health conditions who are dependent on Medicaid, both younger people and adults, said Victor Schwartz, the chief medical officer for a youth mental health nonprofit called theJed Foundation. The people at highest risk for the worst consequences are going to be put in jeopardy.

I have no doubt that this care keeps me alive.

States will undoubtedly have to make cuts to crucial services if they lose federal funding.

Kat H., a 36-year-old single mother from Minnesota who asked not to be identified by her full name because it could affect her employment,is one of the people who stands to lose the most if she cant keep her Medicaid coverage.

I have no doubt that this care keeps me alive, said Kat, who has borderline personality disorder.

Without psychiatric care, I sometimes cant even get out of bed for days, she said.With it, I hold down a fulfilling and rewarding job, parent effectively, and maintain relationships with family and friends.

Kat is a self-employed database contractor who estimates she makes around $20,000 a year.Shes able to afford treatment thanks to Obamacares Medicaid expansion, which the GOP bill aims to end in 2020.

Todd Crouch, 46, has bipolar disorder and benefited from Medicaid expansion in his home state of Michigan. He didnt have health insurance for years, and said the quality of his health care has great improved since he signed up for Medicaid when Michigan expanded the program.

Without Medicaid, Crouch said he would be right back where I was five or six years ago, where I was hopeless.

Im barely putting food on my table, he said.How am I going to afford health care?

Bloomberg via Getty Images
The American Health Care Act, which House Republicans released earlier this month, proposes slashing $880 million to Medicaid. House Speaker Paul Ryan has long supported cutting funding for the program. 

The consequences of untreated mental illness

Issues related to untreated mental illness tend to snowball.

If those people dont have access to care, you lose work days, families break apart, Schwartz said. By virtue of not being able to treat people who are mildly troubled, you wind up with people who are sicker.

A lack of treatment can even be deadly, said Paul Gionfriddo, CEO of the Mental Health America nonprofit.

You end up with people who lose their jobs, who lose their societal supports, lose their families, lose their access to education, lose their housing, he said. And then we see them on our streets and in our jails and prisons, and frankly in our morgues.

And research has shown that mental illness can be harmful to both individuals and society if left untreated.

A 2008 study funded by the National Institute of Mental Health before Obamacare took effect found that people with mental illness who werent able to work cost the U.S. economynearly $200 billioneach year. Incarcerations, homelessness and physical health problems connected to poor mental health only add to that cost.

Where do people think the people on the corners asking for money come from? said Gionfriddo. Where do they think people who are chronically homeless come from? he added. Where do the think people in county jails and state prions come from? All of those are visual representation real life, real time of what happens when you have an inadequate system for mental health services and supports.

The GOPs plan to replace Obamacare would end up making health care even less accessible to millions of Americans, particularly tolow-income people. Around one-third of Medicaid beneficiaries suffer from mental health issuesor addiction, according to the Department of Health and Human Services.And Trumps federal budget planonly makes things worse for the poor, with cuts tokey programssuch as affordable housing, job training and legal counseling.

If I dont have my mental health, Im not able to go to work — and then what would I do? Kat H.

Research indicates that there is a direct correlation between poverty and mental health issues. Low-income people are more likely to suffer from mental illness, according toa report from the New York Universitys McSilver Institute. This is partly because theyre less likely to be able to afford treatment and partly because the stress of poverty can exacerbate existing mental health problems.

Im barely making it happen financially with my situation right now, Kat said.There are some days where we have beans and rice for dinner because thats all I have enough for in my bank account. The stress about it makes me crazy, it makes me lose sleep. If I dont have my mental health,Im not able to go to work and then what would I do?

Gionfriddo said his 32-year-old son, Timothy, has a serious mental illness and relies on disability benefits and affordable housing to stay out of jail and off the streets.

He has been making a concentrated effort to come in off the streets, he said. But you make that impossible to happen if you cut these other programs.

The GOP has a history of cutting mental health services

The Affordable Care Act has been seen as a major win formental health care.The expansion of Medicaid, coupled with increased accessto private insurance,filled gaps widened over the years by state and federal cuts to mental health services.

People with mental illness are an easy target from a purely political perspective, said the Jed Foundations Schwartz. Theres not a strong lobby, theyre not giving political contributions or in many cases not even voting.

Mental health servicesare often among the first issueson the chopping block when budgets get slashed. The mental health care system lost around $4.35 billion after the 2008 financial crisis,according to the National Alliance on Mental Illness. Although much of that money found its way back into budgets, some systems never recovered. Several states, includingFlorida,NevadaandMichigan,are currently weighing cutting millions more.

Some Republican lawmakers, though, are fighting to keep the American mental health care system afloat.

In aletter to Senate Majority Leader Mitch McConnellthis month, Sens. Rob Portman (R-Ohio), Lisa Murkowski (R-Alaska), Shelley Capito (R-W.Va.) and Cory Gardner (R-Colo.) expressed serious concerns about the AHCAs effects on mental health.

Any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services, the lawmakers said. We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our countrys most vulnerable and sickest individuals.

During the 2016 campaign, Trump pledged to protect Medicaid and Medicare. But he also said he would be open to funding the programs through block grants, which opponentssay could lead to reduced benefits. And it appears Trump has shifted further away from his campaign promises since taking office, supporting the Houses health care bill and hinting at dramatic changes for Medicaid recipients.

Although Trumps budget may claim to want to help people with mental illness, patients advocates arent so sure.

Until we see all the numbers,its really hard to understand just how much of a commitment is here beyond the words, Gionfriddo said.

While politicians tinker with budgets and weigh which cuts will hurt the least, patients are left without answers.

This is not some hypothetical, academic debate, Kat said. This is my real life.

CORRECTION:A previous version of this article stated that the Republicans health care plan involved $880 million in cuts to Medicaid. That figure is $880 billion.

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