Repealing ObamaCare will threaten our mental health

When Former President Barack Obama signed the Affordable Care Act (ACA) in 2010, my first and most overwhelming emotion was relief.

Not because I or any of my family members needed the law — we’re among the fortunate who have never had to go without decent health insurance. Rather, my relief was that of a future physician who could stop fearing that giving a critical diagnosis might sentence a patient to a lifetime of skyrocketing insurance premiums or dropped coverage.

At a more basic level, from the ACA sprang the hope of being able to practice medicine without having to ever ask a patient the question, “can you pay for this?”

{mosads}That was in my first year of medical school. By the time I started my residency as a psychiatrist in 2014, most of the ACA’s key provisions had gone into effect. It was only then that I could truly take the measure of the law’s impact.

For the more than 40 million Americans suffering from mental illness and roughly 20 million suffering from a substance use disorder in any given year, the pre-ObamaCare era was a nightmare. Insurance companies could set arbitrary limits on annual care, exclude behavioral health benefits, or deny coverage altogether.

Those diagnosed at a young age — common in many psychiatric disorders — could expect to spend the rest of their lives fearing they might be dropped from their plan due to a pre-existing condition.

Moreover, because the most serious mental illnesses can make regular employment difficult or impossible, many patients were unable to obtain reliable insurance through employment. Turning by necessity to public programs like Medicaid, they often encountered strict limits on eligibility and limited access to providers.

The ACA has dramatically improved the fortunes of those with mental illness, addressing each of these concerns while promising to better integrate behavioral healthcare into the broader health system.

For those who rely on private insurance, the law offers security to people who never previously knew any. For the most seriously mentally ill patients, an expanded Medicaid has become a cornerstone, offering access to quality community-based services that help keep them in the community, and out of hospitals or jails. Now, just as these gains are solidifying, congress is threatening to undo them by repealing the ACA.

Republican leaders insist they will replace the law, suggesting they can safeguard its most favored features while jettisoning the rest. But, their various proposals — to the extent they have even been formulated — fall far short. They have, for example, promised those with pre-existing conditions that they will remain covered. Yet, no one has explained how to accomplish this feat without fatally undermining insurance markets by eliminating the insurance mandate and premium subsidies.

From the psychiatrist’s perspective, there’s a sad irony in the impending demise of the ACA. Should the law be repealed, it will come at a time when deaths from overdose and suicide, both tragic markers of profound mental suffering, are spiking throughout many parts of the country.

It’s not unfair to describe such deaths as part of an epidemic of mental illness and addiction, one that has perhaps affected the white working class more than any other single group, particularly in America’s most economically hard-hit communities.

The irony is this: many of these communities are largely made up of the very voters who delivered the presidency to Donald Trump.

These voters are understandably frustrated by ObamaCare’s missteps, complexities, and costs, including rising insurance premiums for some. Despite the law’s shortcomings, the repeal of the ACA will abolish precisely the safeguards of which so many are urgently in need at this moment: The right to quality healthcare, without regard to ability to pay, even when you have a chronic condition, even when that condition is a mental illness.  

On the eve of ObamaCare’s repeal, the mentally ill across the country, regardless of race, gender, or economic status, are vulnerable.

Alongside so many others people lacking steady work, or who have ever received a significant medical diagnosis of any kind, or who are facing major medical expenses like chemotherapy or surgery those suffering from mental illness may soon find that, once again, healthcare in America is a privilege, not a right.

At this moment, we can only ask that, as the new Republican-led government moves forward, its leaders consider how their path will so deeply affect the lives of millions.

Jacob Izenberg, M.D. is a psychiatry resident at the University of California, San Francisco. He studies the relationship between social policy and health.

The views expressed by contributors are their own and not the views of The Hill.