On Monday, House Republicans introduced legislation to gut mental health care for millions of Americans.

For individuals enrolled in Medi-Cal, the legislation will enact a per-capita cap, or a limit on federal spending for each Medicaid enrollee. For enrollees with significant health costs, including prescription drugs, on-going treatments, and hospitalizations, this will mean that costs above the cap must be covered by the state or by the enrollee. California stands to lose at least $20 billion, or one fifth of our Medi-Cal program, which will force the state to make dramatic cuts to eligibility and benefits.

The legislation also dismantles the Medi-Cal Expansion. Thirty percent of those newly eligible for coverage are living with mental illness and/or substance use disorders, the majority previously uninsured. While people who are currently enrolled in Medi-Cal will be able to remain covered, new enrollment will be frozen in 2020. Additionally, anyone with a coverage gap of more than one month will lose his/her coverage.

Additionally, beginning in 2020, the Essential Health Benefits requirement in Medicaid would be eliminated, including mental health and substance use treatment. California will have the option of whether or not to require Medi-Cal Managed Care plans to provide these benefits in light of decreased federal funding for the program.

For individuals enrolled through Covered California, income-based tax subsidies will be eliminated and replaced with an unspecified and discretionary fund for states. Additionally, for commercially insured individuals, the prohibition on discriminating on the basis of pre-existing conditions, including mental health conditions, will be eliminated. Individuals who have not maintained continuous coverage will be required to pay a 30% penalty beginning in 2019.

This past week thousands of constituents showed up at California town halls, vigils, and search parties for Republican representatives back in district but missing in action on health care. Democratic leaders were also drawing crowds. More than 2500 people gathered in Santa Rosa Saturday to hear Congressman Mike Thompson and other lawmakers discuss the effects of repealing the ACA. The press is paying attention to the public outcry, and polling shows that support for the ACA is at an all-time high. The pressure on D.C. lawmakers to come up with a replacement plan for the ACA isn’t just coming from voters. Governors, including John Kasich (R-Ohio), gathered this week, calling for a plan that will protect the millions of dollars in Medicaid expansion their states receive. But a leaked GOP ACA replacement plan did little to assuage their fears. Among other things, the plan would undermine the two main ways Californians get coverage, through Medi-Cal and on the job benefits.

CPEHN is concerned that the Republican proposal for replacing the Affordable Care Act (ACA) will lead to less care at higher cost for communities who least can afford it. After six years of attempting to repeal the ACA without a viable replacement plan, Congressional Republican leadership released another white paper on Thursday, February 16, outlining their ideas. Republicans insist their ideas will be “better” but they are only moving us in the wrong direction.

CPEHN believes a better health care plan must:

Within the first few weeks of the new administration, there has been tremendous threats to our quality of life. We have seen a surge in actions against our healthcare, our education system and immigrants to name a few. We are afraid for our communities when it comes to whether or not they will have access to healthcare coverage and if their families will be able to stay together. We are challenged in new ways and we know this is just the beginning of a long battle ahead. CPEHN is committed to ensuring health justice and equity for communities of color and we refuse to give up. 

We are thankful to our partners and other advocates who have been on the frontlines and have pushed back against the proposed changes by the new administration. The response to preserve the gains we’ve made has been incredible and shows our solidarity is strong. We are also grateful to our donors who support our efforts during this critical time. Specifically, we would like to thank California Health Care Foundation and Blue Shield of California for their generous grants. We are proud to be one of nine organizations to receive Act Now funding to continue to defend our healthcare. We look forward to our partnership with them.