PT: SAMHSA Head Fears 'Huge Loss' in Access to MH Services Under ACA Repeal

Mental Health Chief Warns 'Huge Loss' If Protections Go Away Under ACA Repeal
By Brianna Ehley Politico January 5, 2017

The nation's top mental health programs official warns of a “huge loss” for people in need of mental health and addiction treatment if certain Obamacare protections go away.

Kana Enomoto, who leads the Substance Abuse and Mental Health Services Administration, is a nonpartisan career civil servant who will continue her service under the Trump administration. In an interview with POLITICO, she acknowledged the likelihood of negative consequences if Republicans repeal the Affordable Care Act without preserving coverage and parity protections for people with mental illness.

“It would be a huge loss for the nation’s health should we lose that level of coverage and access,” Enomoto said. “It’s my responsibility to present what the science tells us and how the services being offered are benefiting the nation’s health and what happens if they go away.” She added that she had not yet spoken to the Trump administration about repeal plans.

HHS estimates that 60 million people with mental illness and substance abuse disorders have benefited from coverage protections provided by the ACA. That includes provisions dubbing mental health treatment an essential health benefit insurers must cover on par with medical care, and a ban on insurers denying coverage to people with pre-existing conditions, such as chronic mental illness.

These gains would be lost with a full repeal of the law.

Senate Republicans on Wednesday officially began the process to dismantle major pieces of the law through a tool known as budget reconciliation. They expect the GOP-controlled Congress to approve the measure and to have it ready for President-elect Donald Trump's signature shortly after he takes office on Jan. 20. The timeline for a replacement of the law — and exactly what that replacement will be — is not yet clear.

Trump earlier this year said he was open to keeping in place the ACA's guarantee of access to coverage for those with pre-existing health conditions. However, that provision's survival is not a certainty. Sen. Bill Cassidy , author of one Obamacare replacement plan, said he wants to do away with the health law's essential health benefits provision, but told POLITICO his plan would “make sure folks have access to care that is needed.” He did not provide further details when asked specifically how he'd guarantee such access.

Due to newly passed mental health reform legislation that created an assistant secretary for mental health, Trump will soon have a politically appointed leader at SAMHSA to whom Enomoto -- who currently heads the agency -- will report. The person who holds the new position will serve as the top official in charge of mental health and substance abuse programs. Enomoto, who serves as the deputy assistant secretary for mental health, is already working on implementing the new law, which includes $1 billion in funding to assist states hit hardest by opioid abuse.

The measure also authorized new and existing treatment and prevention programs, which won't be appropriated until the fiscal 2018 budget at the earliest.

Though Enomoto will not be at the top perch of SAMHSA, she said her priorities for the agency will include continuing the fight against opioid abuse, promoting the integration of behavioral health into the primary care setting, beefing up suicide prevention efforts and enhancing the behavioral care workforce, which is desperately lacking such specialties as child psychiatrists.

It's not yet known who Trump will tap to lead the agency in the new administration.