Medicaid, Mental Illness, and Malpractice

by Charles Katebi

In the eyes of progressives, Obamacare provides for all of society's needs: It creates jobs! It heals the sick! It balances state budgets! Now the Obama Administration claims it expands healthcare access to patients with mental illnesses.

According to a report from the US Department of Health and Human Services, 1.9 million low-income individuals with mental illnesses reside in states like Wyoming that rejected Obamacare's Medicaid expansion. And if only lawmakers in these 19 states expand this welfare program, vulnerable individuals will get the care they need.

Obamacare's cheerleaders have predictably hailed this study for vindicating the President's policies:

"The conclusion is clear: If states are serious about tackling mental illness and opioids, then expanding Medicaid offers a unique opportunity to do so," Richard Frank, assistant secretary for planning and evaluation at HHS, said in a call with reporters.

Unfortunately, Medicaid is a terrible program for treating mental illness.

Beginning in the 1990's, innovative new drugs known as atypical antipsychotics that treat schizophrenia and bipolar disorder came onto the market. By targeting specific receptors in the brain, these medications give patients their feelings back, produce fewer muscular side effects, and don't cause cognitive losses like older pills. These drugs even save money long-term by making patients healthier.

Yet despite these enormously positive outcomes, Medicaid aggressively limits patient access to atypical antipsychotics, citing their high sticker price. Over a third of states impose a variety of restrictions on these new drugs. In Kentucky, Medicaid withholds atypical antipsychotics like Risperdal and Zyprexia until a patient suffers a psychotic break. Wyoming has similarly restrictive measures. In the name of saving money, Medicaid deprives society's most vulnerable patients of essential medicine.

By keeping patient sick, Medicaid's cost-control measures actually wind-up costing more for taxpayers. A report published in the American Journal of Managed Care (AJMC) found that patients with bipolar disorder in states that limit access to atypical antipsychotics had 16 percent higher inpatient costs than patients in states without these restrictions. Patients with schizophrenia winded up costing 23 percent more. This is because schizophrenic patients are 50 percent more likely to undergo hospitalization when their prescriptions aren't refilled within 10 days; a consequence of Medicaid's onerous rationing.

Medicaid's inhumane approach to mental illness even pushes patients into our prison system. When at-risk patients can't access the medicine they need, too often they become a threat to themselves and others and force law enforcement to intervene. According to the same study, Medicaid's antipsychotic restrictions increased the nationwide prison population by 9920 and raised incarceration spending by $350 million in 2008. Rather than help patients, Medicaid leaves them to languish in jail cells.

Medicaid also crowds-out many state programs that address mental health. In a Health Affairs report ominously titled Medicaid And Mental Health: Be Careful What You Ask For, it reads:

"It is unfortunate that a likely consequence of Medicaid growth has been to shift funds away from the care of a population that in many respects closely resembles Medicaid enrollees. This aggravates the problem of the uninsured, since people with mental disorders are overrepresented in this population."

Bottom line: the more Medicaid spends, the less states have to fund community-based mental health programs, making it harder to treat patients in crisis. According to the National Association of State Mental Health Directors, states cut $5 billion in mental health services between 2009 and 2012. In addition, they eliminated 4,500 public psychiatric hospital beds- nearly 10 percent of the nation's supply. Does this sound like better healthcare access?

Patients with mental illnesses require the utmost compassion and support to ensure they live productive and meaningful lives. But entrusting their care to a callous bureaucracy like Medicaid isn't the answer.