We are on the eve of Congress enacting radical changes to the American healthcare system, including proposals to significantly restructure the Medicaid program. Republican leadership in the Senate is working to swiftly finalize a bill to repeal and replace the Affordable Care Act (ACA). Although many details are still unknown, the House-passed American Health Care Act (AHCA) included proposals to enact per capita caps or block grant Medicaid, resulting in a $834 billion cut to the program—the single largest source of funding for mental health and substance abuse treatment in the United States.
Some Americans, including members of Congress, have a distorted view of what the Medicaid program is and who it serves. Let me introduce you to an often-overlooked group of the Medicaid population—America’s veterans, a demographic currently facing a mental healthcare crisis resulting in the highest suicide rate in the country.
Our nation’s current healthcare debate ensuing in the halls of Congress is ignoring the fact that not all veterans receive their health care through the Department of Veterans Affairs (VA). In fact, only 40 percent of America’s approximately 22 million veterans are enrolled in and receive all or part of their care through the Veterans Health Administration (VHA). Eligibility depends on minimum service requirements, disability ratings, and discharge status. Additionally, millions of veterans living in rural areas find it impossible to access care at a VA facility. These factors combined leave a significant gap in access to healthcare.
For approximately 1.75 million veterans—nearly 1 in 10—Medicaid fills this gap and for many, is the sole source of coverage for primary and specialty healthcare. Efforts to cap and cut Medicaid risk the health and well-being of veterans most in need. In addition, many veterans require intensive care for service-related injuries, including mental health conditions, and are at particular risk if the program is cut.
America’s veterans already face many barriers to accessing quality care and congressional actions to cap and cut Medicaid or phase out Medicaid expansion entirely, would make it impossible for veterans to get necessary health services. In fact, 340,000 veterans would lose their coverage in 2020 if Medicaid expansion is ended. As experts who work with the military community know, stigma is still one of the main reasons veterans are apprehensive in seeking care for a mental health condition. In a culture that demands strength, it is often difficult to step forward and seek help for an injury, such as PTSD, that remains unseen. For this reason, adding another large barrier to accessing mental health services would result in deadly consequences.
Let’s consider for a moment, veterans who served in Iraq or Afghanistan struggling with post-traumatic stress disorder (PTSD), substance use disorder and other mental health conditions who are relying on Medicaid to cover all or part of their care. The mental health therapies and medications they are receiving is calming the nightmares and flashbacks they experience as witnesses of war—putting them on a pathway to recovery.
The proposed draconian cuts to Medicaid threaten to end coverage for this population, a group of dedicated Americans who have sacrificed so much for our Nation’s greater good. Men and women who answered the highest call to serve when freedom hung in the balance.
Most alarmingly, this proposed cut to care comes at a time when 20 veterans die each day by suicide. This places the risk of suicide for veterans at a 21 percent higher rate than civilians. As a nation, I believe we can and we must do better.
Healthcare for our Nation’s veterans is an issue that should be placed above incessant partisan bickering and the political games of Washington. As the Senate outlines the framework for our Nation’s health care policy, I expect our leaders in Congress to come together and take the time to work out common sense solutions to ensure we do not leave nearly 2 million of our veterans behind and without access to the care they need.
Blair is Manager of Military & Veterans’ Policy, NAMI, National Alliance on Mental Illness. NAMI is the nation’s largest grassroots mental health organization, dedicated to building better lives for the millions of Americans affected by mental illness.
The views expressed by this author are their own and are not the views of The Hill.