ACA Repeal Would Strip Millions of Behavioral Health Coverage, Hurting Safety Net Providers

As the Supreme Court considers the fate of the Affordable Care Act (ACA), the behavioral health coverage of more than 12 million people is hanging in the balance. 

That’s the case because the ACA gave states the option to expand their Medicaid programs, allowing them to cover a larger swath of people. Under Medicaid expansion, those who are uninsured and have incomes of up to 138% of the federal poverty level are eligible for coverage. Plus, beneficiaries covered under Medicaid expansion are guaranteed a certain level of mental health and substance abuse coverage, which isn’t always the case under other payers. 

Since Medicaid expansion’s inception back in 2014, about 12.4 million newly eligible people have gained health care coverage, MACPAC data shows. Between July 2013 and January 2020, that represents an enrollment increase of nearly 33%.


But if the Supreme Court rules to repeal the ACA, all that would change. Americans covered under Medicaid expansion would no longer be eligible for the program.

Not only would the ruling have a negative impact on those beneficiaries, but it would likely hurt behavioral health organizations, too. 

That’s especially true for safety net providers operating on razor thin margins. Because they care for the under- and insured, these behavioral health organizations would likely continue to treat these patients — but they’d stop getting paid to do so. 


However, there is some good news for behavioral health providers: At the point, it seems likely that the Supreme Court will uphold the ACA. 

For one, key justices have expressed their support for the legislation. Voters have, too. 

According to polling data from the D.C.-based market research company Morning Consult, voter favorability for the ACA is at an all-time high.

“We saw 62% [of voters], in September, say that they had a favorable impression of the Affordable Care Act and they support the Affordable Care Act,” Caroline Bye, associate vice president of client services at Morning Consult, said during a recent webinar hosted by the National Council for Behavioral Health. “I will be curious to see if the court ultimately sides with the court of public opinion in their ruling.”