Senate Health Reform Bill Takes Us Backwards


One in five Americans are affected by mental illness, and more than 50% do not receive treatment. We need more coverage for mental health care, not less.

The Senate health reform bill, the Better Care Reconciliation Act of 2017 (BCRA), will take us backwards.

The BCRA will allow states to let health insurance plans drop mental health and substance use coverage. It is an injustice to suggest that mental health coverage is optional.

The Senate bill will also devastate community mental health programs by cutting Medicaid funding, making it harder for people to get psychiatric medications, case management and mental health services.

If the Senate passes this bill, it will result in less mental health care and shift people with mental illnesses into already-strained emergency rooms, hospitals and jails.

Help keep the promise of better mental health care alive. Tell your Senators: Vote NO on the BCRA.

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Learn more about the impact of the BCRA on mental health coverage below:

Marketplace Health Insurance Plans

  • Increases eligibility for tax credits to people below 100% FPL ($12,060 per year for a single adult in most states), which will increase support to the lowest income Americans;
  • Requires coverage of children up to age 26 on plans; and
  • Keeps the ACA requirement to cover people with pre-existing conditions, like mental illnesses; BUT
  • Allows plans to charge older people 5 times more than other people; and
  • Allows states to get waivers permitting health insurance plans to:
    • Make mental health and substance use coverage optional (if benefits are made optional, parity no longer applies)
    • Change or eliminate maximum out-of-pocket limits

Medicaid Expansion

  • Allows non-expansion states to expand Medicaid eligibility, but limits eligibility to 133% FPL ($16,040/year for a single adult in most states) or below--and at a lower federal match rate than other expansion states;
  • Effectively phases out Medicaid expansion by decreasing federal funding to the standard federal match rate for traditional Medicaid by 2024; and
  • Makes mental health and substance use services optional in Medicaid expansion plans after 2019 by eliminating the requirement to cover essential health benefits.


  • Allows states the option to cover psychiatric hospitalization in a psychiatric hospital (IMD) for up to 30 consecutive days in a month -and up to 90 days in a year;
  • Allows states to adopt work requirements for people (including those with mental illness) who are not on federal disability (SSI/SSDI);
  • Changes Medicaid funding to a per capita cap, a fixed amount of funding per person;
    • Per capita cap funding in Senate bill is expected to result in even deeper cuts to traditional Medicaid than under the House bill because it includes a less generous rate increase for inflation;
    • Per capita caps mean that states will no longer get matching federal funding based on costs-if a state’s medical costs are higher than expected, the state is left with the bill; and
    • States may choose a Medicaid block grant instead of per capita caps (a fixed total amount of federal funding) for non-disabled adults.