Among the relentless flow of President Trump’s executive orders over the past two weeks, the one instructing Congress to move toward repeal of the Affordable Care Act, also called Obamacare, received comparatively little attention. Perhaps this is because, unlike banning immigrants from entering the country, it was far less obvious that revising health care eligibility for millions could happen with the stroke of a pen.
But the debate in Congress will heat up soon enough, presumably with the confirmation of a Secretary of Human Services. When it does, we should all, especially clergy, enter the fray — and not just for the obvious reasons.
Yes, over 20 million individuals now have access to health care who otherwise would be left out in the cold, including over one million children. That achievement is more than sufficient cause to oppose repeal without a clear replacement.
A less well-known but crucially important reason to fight repeal is that Obamacare – without fanfare – has given us something our nation has never had before: the real possibility of caring for our mentally ill, and those struggling with drugs.
Throughout our national history we have shamefully neglected the mentally ill; as for drug addicts, we are more likely to jail them than to provide treatment. This landmark legislation was on the verge of changing all that.
The mechanism is disarmingly simple: the ACA provides coverage for ten “essential health benefits,” including ambulatory services, hospitalization, emergency services, maternity and newborn care, rehabilitative services, and others. The list includes inpatient and outpatient care to treat a mental health condition or substance abuse.
We desperately need these services. A national opioid crisis claimed over 33,000 lives in 2015. What possible sense does it make to eliminate the eligibility, and most likely, the funding for treatment for the victims of this national calamity, especially our youth?
With ACA repeal, about 2.8 million Americans would lose their eligibility for substance abuse treatment, including 222,000 addicted to opioids. Repeal would be especially damaging in economically depressed rural areas, where over 30 million people have no access to life-saving medically assisted treatment such as naloxone.
It is ironic that we are facing the massive elimination of mental health and drug treatment just when we had begun to make national advances in these areas. It was a major breakthrough in 2008 when Congress passed The Mental Health Parity and Addiction Act requiring that eligibility and benefit levels be the same as those for medical and surgical coverage.
In 2014 Congress approved The Comprehensive Addiction and Care Act, including nearly $1 billion over two years, to combat our heroin crisis. Repealing Obamacare would eliminate $5.5 billion available for this same purpose, thus effectively overriding this legislation.
Police departments all over the nation have begun to steer heroin addicts to treatment rather than arresting them. We responded quite differently to the crack epidemic when it broke out in African American neighborhoods in the 1980’s. But we can applaud what these police departments s are doing even as this disparity underscores the institutional racism so visible in our history – and our present.
All of us should mobilize around fighting the repeal of Obamacare. Clergy have a special reason to do so. For too long the mentally ill and the addicted have lived in the shadows. If Obamacare is gutted, they will be the first to be cast aside. We have a special responsibility to those whom society cares for least.