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Michael Butz


Well, this is the third guest opinion I have felt compelled to write on efforts to repeal the Affordable Care Act. Previously, I encouraged Montanans to “act your conscience and contact your legislators.” I urged action after recognizing how many Montanans would lose health insurance if the ACA were repealed without certain considerations. The numbers of Montanans losing care paralleled the populations of whole cities, not towns. Now, the latest ACA repeal effort is best described as Congress flying blind at high speed to beat a Sept. 30 cut-off for an easier win.

The fiscal year ends on the 30th, and the Senate has until then to use “reconciliation” to pass a funding bill on a simple majority vote of 51. So, certain factions in the Senate are moving quickly to vote this week, despite an apparent blindness to the financial and human impacts of the bill.

My previous comments about whole cities losing insurance was based on the results of the Congressional Budget Office’s work. Now, little time exists for the customary analysis CBO provides; and many health care experts believe the current bill is far worse than the prior two.

Lives and their quality hang in the balance of the Graham-Cassidy ACA repeal bill. It recycles the following harmful provisions from previous efforts to repeal the ACA:

  • It allows states to waive minimum benefit package requirements and pre-existing condition protections.
  • It allows states to drop ACA requirements for mental health and substance use disorder coverage.
  • It drastically cuts federal Medicaid funding by implementing a “per capita cap” or block grant system and ending the ACA's Medicaid expansion by the end of 2019.

In addition, preliminary analysis indicates that Graham-Cassidy would reduce federal funding to states, by hundreds of billions of dollars.

As before, my national organization, the American Psychological Association, maintains that no health care reform legislation should be passed by Congress unless it covers at least as many people as the ACA. This coverage must ensure decent, reliable health insurance — including behavioral health care services such as mental health and substance use treatment. This continues to be my position as well.

Once again I ask each of you to ensure you know how this legislation will impact you. Please consider the premise that moving forward with this bill means that we are flying blind at high speed, and with all of our citizens on board the flight. Please consider this, act your conscience, and contact your legislators to take action!

Michael R. Bütz, Ph.D., of Billings, is federal advocacy chair for the Montana Psychological Association.