The Robert Wood Johnson Foundation (RWJF) released a report last week that said the American Health Care Act (AHCA), which is being considered by Congress to replace the Affordable Care Act (ACA), could reduce access to mental health care, substance abuse treatment and parity of insurance protections.

 

Parity protections guarantee that behavioral health care insurance coverage is the same as for all medical conditions, including those preexisting prior to purchasing health insurance. Parity protections were partially implemented by passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act of 2008 and extended by passage of the ACA in 2010, also known as “Obamacare.” Prior to 2008, about two-thirds of rural insurance-holders with employee-sponsored or personally paid insurance plans had limits on outpatient behavioral health care coverage.

Many farmers, ranchers, agricultural workers and their families who needed professional behavioral health care the most – like those with chronic conditions such as recurring depression, bipolar disorder and neurological injuries – were excluded. They sometimes avoided treatment because of the high costs.

The ACA fixed these problems. Replacement of the ACA with the AHCA and President Trump’s health care budget proposal would largely reduce health care insurance coverage among the rural and agricultural populations in general, including behavioral health care insurance coverage.

The people involved in agriculture, and all residents of rural areas for that matter, need to know relevant information that could eventually affect their capacity to obtain desired health care insurance, especially for behavioral health care.

This column is aimed at providing information without any intended political bias, while making behavioral health care more understandable and acceptable, as well as accessible and culturally appropriate for agricultural people and other rural residents.

The ACA needs fixing, but the AHCA and President Trump’s health care plans are not the answers to what needs to be done. If either is implemented as currently proposed, the nonpartisan Congressional Budget Office estimated in late March that 8 percent of the insured people in the entire United States (about 24 million), and a somewhat larger percentage of rural residents, would lose their health insurance coverage.

The nonpolitical RWJF says rural America, where most of the U.S. agricultural population reside, has a greater share of the poor and unemployed than urban and suburban areas of the country.

Rural hospitals would struggle to remain open even more than they are currently, says the National Rural Health Assoc., which is opposed to both the AHCA and President Trump’s budget proposal in their present forms.

Rural and agricultural people, the majority of whom voted for Trump and Republican candidates in last November’s election, would be affected the most if the ACA is replaced by either of the currently proposed alternatives. It makes the most sense to focus on what needs to be fixed in the present ACA.

Polls say nearly everyone likes the ACA coverage for preexisting and chronic health conditions, and the extension of health care insurance coverage to children up to age 26 on their parents’ policies.

A large majority of the insured population also like the parity of coverage for behavioral and medical health care services required by the ACA.

The current increases for ACA insurance coverage would be lower if the pool of insured people included everyone in the country. California and Nevada are experimenting with universal health care insurance coverage using a single payer system. Massachusetts was the first state to require that all residents have health insurance, which was passed when Mitt Romney was its governor; the ACA was partially modeled after Massachusetts’ approach.

Federal legislators and the executive branch can learn from these experiments in choosing what to retain as they modify the current ACA. What else, if anything, needs to be done?

Should we look at a single payer health care system for everyone and require all legal residents to have health care insurance, while also making private health care available to those who can afford it, like many countries provide currently? Such an approach preserves health care options for everyone while guaranteeing health care for all.

 

Currently, many insurance and health care provider companies oppose the 20 percent limitation for administrative costs imposed by the ACA. Administrative costs are higher than 20 percent of income for most health care organizations that don’t affiliate with the ACA.

According to the Kaiser Foundation, about 2 percent of Medicare expenditures are for its administration. Having this single claims processor and payer saves money and speeds up reimbursement to providers of Medicare services. Many Americans endorse a Medicare-type program for everyone and elimination of the need for supplemental insurance (Part B) and drug coverage (Part D).

Additional modifications of the ACA might include the following: bargaining for the lowest prices for medications with their manufacturers and suppliers; recycling of unused and unexpired medications instead of their disposal; placing reasonable limits on medical malpractice awards; and limiting excessive charges by some health care providers.

Can agricultural and other rural people afford to not reform the ACA? You decide.

The views and opinions expressed in this column are those of the author and not necessarily those of Farm World. Dr. Mike Rosmann is a psychologist and farmer in western Iowa. Readers may contact him at mike@agbehavioralhealth.com