AHCA Approved By House
What does its passage mean in California?
Last week the House of Representatives passed the American Health Care Act by the narrowest of margins, with all Democrats and 20 Republicans voting no. It succeeded because of amendments to satisfy the so-called "Freedom Caucus" of very conservative Republicans, who objected to the bill in March, because it left too much of the Affordable Care Act intact.
The key amendment was to allow states to eliminate pre-existing condition protections, and replace them with high risk pools that could be subsidized with federal funds.
The main focus of the media was on pre-existing conditions, which will include and adversely affect, people with mental illnesses and substance use disorders. Both would be considered pre-existing conditions, even if the only treatment was one or two visits to a therapist, or a single prescription for an antidepressant.
Not Likely To Pass In Senate Without Major Changes
At least for this year it seems unlikely that a bill that goes this far will be enacted. Several Senate Republicans are on record opposing cuts in Medicaid, with at least one stating that Medicaid expansion is essential in fight the opioid epidemic.
Accordingly, experts in Washington give the bill no chance of passage in the Senate in its current form. Whether there is some type of compromise that would generate the sufficient votes in the Senate is impossible to predict at this time. In any event, we in California will have no direct influence over the handful of Senate Republicans in whose hands our fate presently seems to rest.
All 14 California Republicans Voted For The Measure
We have 14 House Republicans in California that are neither in the conservative block nor the moderate block of Republicans who were opposed to the bill last month. Last week it appeared as though several of them had reservations about the bill; at least one congressman (Jeff Denham) was opposed before the final amendment that added funding to the high risk pools.
All 14 voted for the measure, including the seven representing congressional districts carried by Democratic presidential candidate Hillary Clinton. This has been interpreted to mean that they were convinced that the political advantages of fulfilling the promises made to repeal Obama Care, and the opportunities presented by remaining in good graces with the President and House leadership, as well as their own political base, outweighed the risks of offending the many constituencies who may work against their reelection next year.
Develop A Relationship And Tell Your Story
Our role at this time is to continue to build relationships and educate others about how behavioral health problems affect all of us, and how important it is to have insurance coverage and federal funding to address these issues.
If you are a consumer or family member, your personal story is extremely powerful and important. You don't need to have a story like Jimmy Kimmel's baby to make the point about a pre-existing condition. Simply state what you have been through and the amount of care that has been, and will be, required.
Make sure to cover the fact that most adults with severe mental illness lose their jobs and employer-provided insurance and must depend on Medi-Cal, which this law significantly cuts.
If you are a provider, talk about the success you've had with the people you serve. Tell them how many fewer of them you'd be able to serve if millions of people lost their public or private health insurance.
Governor's May Revise Budget Will Be Out On May 11
In most years, we have a pretty good idea of what the revised budget will do, as it usually continues the trend that existed in January. However, this is a very unusual year. April tax collections were below expectations, but we also had the major IPO from Snapchat. That was bigger than the one from Google 10 years ago, which was credited with balancing the state budget all by itself and could mean increased revenue forecasts for 2017-18. We also don't know how cautious the financial forecast will be, based upon fears of cuts in federal funding. Had the House failed to pass a health care measure, those fears likely would've been significantly reduced. Its passage could lead to a continued cautious forecast, even though Senate passage is unlikely.
A more optimistic budget forecast could lead to restoration of the $17 million in Youth Crisis funding that was cut in the Governor's January budget, as well as other budget priorities such as the realignment of In-Home Support Services that would reduce County mental health funding by $25 million in 2017-18, and increasing annual amounts thereafter.
A cautious budget puts these funds at risk and requires an all-out effort to get legislative leaders to make these the top priority in their negotiations with the Governor. We will have a special update sent to our members and an advocacy request if that looks necessary when we see the May Revise.