“Repeal and Replace” and the Mentally Ill

theaca .jpgGiven that the apocalypse is nigh, I’ve been digging into the policy implications of a – in the words of Elizabeth Bishop, “write it!” – Donald Trump presidency for mental healthcare, which is something I’m not even sure he’s done.

By sheer virtue of his (and literally every conservative’s) desire to repeal the Affordable Care Act, it will be a disaster. Mentally ill patients have mastered the art of losing healthcare, and it looks like the next four years will be no different. Okay, no more Bishop.

In writing this, I found I don’t have much to work with. Trump’s stance on mental healthcare is vague – shocking. Reading it felt like a joke or an insult to people’s intelligence, but this isn’t a joke. Today is the day, people. So here is the Trump-Pence website’s official statement:

Finally, we need to reform our mental health programs and institutions in this country. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. There are promising reforms being developed in Congress that should receive bi-partisan support.

To reform healthcare in America, we need a President who has the leadership skills, will and courage to engage the American people and convince Congress to do what is best for the country. These straightforward reforms, along with many others I have proposed throughout my campaign, will ensure that together we will Make America Great Again.


Aside from repealing the ACA, there is nothing, which is disconcerting because in the words of Mental Health America, “half of us will be diagnosed with a mental illness during our lifetime. Mental illnesses are as costly as cancers, and serious mental illnesses reduce life expectancy by more than twenty-five years. 57 percent of adults with mental illnesses say that they do not have access to mental health care.” Their statement on Trump’s looming presidency goes on to talk about the importance of giving mentally ill children adequate resources to succeed in school in spite of their conditions. Betsy DeVos is, well, really rubbing salt in that wound and will likely injure the public school system further.

Clearly, all I can really talk about here is the ACA.

My dad is a small business owner and staunch supporter of “repeal and replace.” I hear about rising premiums, increased competition for worse care, and opposition to the ACA as a matter of rugged-individualist/social-darwinist principle a lot.

I understand the stress of rising premiums and penalties incurred by the ACA for small business owners, but what I don’t understand is why it’s necessary to rip healthcare out from underneath the feet of 20 million Americans instead of simply adjusting the ACA to alleviate the financial stress it places on small business owners. As outlined in a Congressional Research Service report on the economic burden of the ACA, there are ways to improve the ACA such as getting rid of the penalty, increasing the credit so more small business owners feel its worth claiming, and expanding exemptions. All this leads me to believe that “repeal and replace” is political grandstanding more than anything.

Perhaps the most alarming fact is that insurance companies’ profits have increased since the ACA was declared constitutional. Basically, an increased number of customers bumped up stock prices, and insurance companies’ shareholders reaped the rewards. So being forced to cover the sickest Americans – god forbid – really didn’t end up being that much of a financial burden. Insurance companies – not the ACA – are the ones raising premiums because they claim to need the extra funds to cover the new customers, but it looks like they’re just greedy. Making a profit on the backs of Americans who are the most at risk and the most unable to afford lifesaving healthcare is, well, morally reprehensible.

Plus, members of congress have taxpayer subsidized healthcare, so the hypocrisy is a matter of dubious ethics. In fact, I’m entirely unable to process how conservative lawmakers are against something from which they actively benefit. And here’s where the conservative public would say to simply get rid of taxpayer subsidized healthcare for everyone including politicians, but 1) congress would never pass that law and 2) members of congress are likely wealthy enough to be able to afford insurance no matter what. It’s a matter of protecting the poorest and sickest Americans, who conservatives already berate for receiving government benefits because of their inability to work higher-paying jobs or to work at all.

Come to think of it, insuring those who could not afford insurance before the ACA could lead to a larger, healthier, more productive workforce, and since productivity is the capitalist king, conservatives should be all for more inclusive healthcare coverage. Never mind the fact that it would just make people’s quality of life better. I don’t think conservatives are bad people. I really don’t. But rugged individualism only works for people who can afford it. Bear in mind that social mobility is at an all-time-low in the US.

From a mental healthcare standpoint, it’s already difficult for mentally ill people to get adequate coverage for all aspects of their treatment, especially talk therapy, which, trust me, is a critical part of our treatment. It makes sense that the most stigmatized among us will be the first to lose coverage, which will create an even greater undue societal burden since mentally ill people without financial support can quickly and easily become unemployed, homeless, or worse. These are the tangible consequences of stigma – well, more accurately, discrimination.

Sure, adjusting the markets would be difficult, but guess what’s more difficult. Starting over completely.


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