Half of the states in the country have blocked the Affordable Care Act’s Medicaid expansion, denying insurance coverage to 3.7 million Americans with mental illness and substance abuse conditions, according to a new report from the American Health Counselors Association. In five of these states, at least 50 percent of uninsured people could benefit from mental health coverage. Eleven of the states refusing to extend coverage are in the Southeast, where nearly eighty percent of those being denied mental health coverage through Medicaid reside.
But several of the Republican governors standing against Medicaid expansion have previously called for increased mental health resources, particularly following the Newtown massacre and other gun tragedies.
For instance, in 2012, North Carolina Gov. Pat McCrory (R) advocated for mental health services as a better policy solution than gun control. “Right now we have broken system regarding mental health,” he said. “And this type of situation could occur here because of some people with serious mental health issues.”
Early last year, Maine Gov. Paul LePage (R) sent letters to Vice President Joe Biden saying that “the problem we face has little to do with firearm ownership and nearly everything to do with mental health issues.”
Yet both of those states are blocking the Medicaid expansion and have recently overseen drastic cuts to their mental health services. North Carolina’s state psychiatric hospitals served 8,416 less clients in 2012 than 2007, the largest decline in any state over that period, according to the National Alliance on Mental Illness’ 2013 State Legislation Report. Maine’s mental health care spending fell by $27 million from 2008 to 2012.
Meanwhile, Alaska Lieutenant Governor Mead Treadwell, who attended Sandy Hook Elementary as a child, has also advocated for more attention to mental health. While his state’s spending did go up in the last year, 25,000 Alaskans eligible for coverage under Medicaid are being denied access to its crucial resources. And in Louisiana, Governor Bobby Jindal has promoted school safety while cutting millions in funding for low-income youth with behavorial health issues.
Some states blocking the ACA have undertaken their own measures to improve mental health services, like Nebraska. Yet Nebraska still saw a decline in funding over the last year. Overall, nine of the 14 states that did not bolster access to mental health resources between 2013 and 2014 were also preventing Medicaid expansion, which accounts for 27 percent of mental health financing.
There are many areas where states could be working to improve mental health services. A recent report by ThinkProgress found that in 2010, access to state psychiatric beds dropped to its their lowest level since 1850. Public psychiatric hospital beds plummeted from 207 beds per 100,000 people to 21 between 1970 and 2000, according to the federal Agency for Healthcare Research and Quality. Currently, at least 24 states currently do not have computerized accounting of where beds are available for mental health patients.
Alex Leichenger is an intern at ThinkProgress.