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What happens if we lose Obamacare?

Thanks to the ACA, 1.2 million more people received mental health and substance use disorder treatment. What will happen to them?

Yesterday, the U.S. House of Representatives voted 217 to 213 to repeal the Affordable Care Act, also known as “Obamacare,” and replace it with the American Health Care Act. The AHCA now must go to the U.S. Senate for a vote. If it passes, it would radically shift health care coverage for Americans, charging them more for health care coverage if they have certain pre-existing conditions. 

Many of those conditions relate to mental health. As it is, mental health care in the United States isn’t good, and if the AHCA passes, it could get a lot worse. Everyone will suffer, including our children.

The Affordable Care Act Helped People With Mental Illness or Substance Abuse Disorders

The ACA requires insurance providers to cover essential health benefits, including care for mental health issues and substance use disorders. Prior to the ACA, someone who had received treatment for mental illness or substance use disorders could be denied insurance coverage or be priced out of affordable care.

This isn’t hyperbole. Between 2007 and 2009, the number of people denied coverage due to pre-existing conditions rose by a dramatic 49 percent. One out of seven people with pre-existing conditions were denied insurance. People who could buy insurance wouldn’t have coverage for health problems that occurred before they signed up. Thanks to the ACA, 1.2 million more people received mental health and substance use disorder treatment.

The Affordable Care Act became law on March 23, 2010. Many of the major provisions took four years to take effect. Such patient protections included outlawing penalties for adults with “pre-existing conditions” and domestic violence could no longer be considered a pre-existing condition. The rest of the reforms aren’t set to become universal until 2020.

A lack of access and high costs are two of the top reasons people cite for not obtaining mental health treatment in the United States. Psychological medical care saved my life, and I know I’m not the only one. The stigma, shame, and fear surrounding addiction and mental illness are also high on the list of the major reasons many don’t reach out for help. Being punished for trying to get healthy is ridiculous.

Related: Why Checking Myself In To a Mental Hospital Was One of the Best Things I’ve Done

Children Will Suffer

Twenty percent of youth aged 13 to 24 have a mental health condition. Of these young people, 32 percent are in the cycle of incarceration and 37 percent drop out of school. Children who are aged 8 to 15 have a 50/50 chance of receiving mental health care. Ninety percent of child suicides can be attributed to mental illness.

If the ACHA passes the Senate, we are likely to see an increase in the number of children taken from their parents into state custody. Overworked parents who can’t afford childcare will struggle to afford basic health care for their families, and may leave children alone more often, which puts them at risk of state intervention.

Parents are often arrested for leaving their children alone. Summer Pearson, a 25-year-old Florida mother, was arrested in 2016 for leaving her children aged 5 and 3 home alone while she went to work. Susan Terrillion, a Maryland mother on vacation in Delaware, was arrested after she left her 8- and 9-year-old kids home alone for 45 minutes while she went to pick up their take out dinner. These are extremely low-risk scenarios.

A public defender from New York, who declined to be named, said their law office sees a lot of cases like these, and that children experience more trauma when taken from parents than when they’re left home alone. That sentiment is echoed by social workers and psychologists who say there are many other less traumatic and more effective interventions than separating families. These other avenues of intervention include mental health care. Criminalizing parents for leaving children unattended should only be done if “there is a clear, immediate and significant risk to the child’s safety.”

In Other Words, House Republicans Said:

“Don’t leave your kids alone, because it might be dangerous. We want to be really sure you will helicopter-parent to the extreme — we just have to take away that health insurance safety net because it’s been making you lazy. If you really want insurance, you just gotta pay double your monthly income. TBH, we have no idea much you’ll pay! You better tell your kids to be careful because we don’t believe in what the so-called experts say about so-called science. Our solution to lack of childcare is way more badass: We’ll arrest you if you let your kids take risks. They might need some therapy to deal with your overprotectiveness or being put into foster care or to accept that a parent was in jail for half their childhood, but we think they should just…well we aren’t sure what they should do. We also don’t really care.”


Kristance Harlow is a writer, researcher and journalist — and sometimes all three at the same time. She’s a loudmouth intersectional feminist and advocate for awareness of mental illness, domestic violence and addiction. Her grams once told her, “I can see you marrying Indiana Jones.” She responded, “I’d rather be Indiana Jones” and promptly obtained her master’s degree in archaeology. Originally from no-town USA, she has planted roots in India, England, Scotland, Argentina.

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