Written by: Charles Elmore, Palm Beach Post

Congress’s GOP majority risks “political suicide” either by dismantling Obamacare or failing to replace it, partisans on opposing sides have claimed in the heat of the toughest legislative tangle of the Trump administration.

Forgive Amanda Kopacz of Boynton Beach for concentrating more on her daughter, who attempted actual suicide last year.

“It’s literally life and death,” said Kopacz, 39. “It’s whether we can afford the $1,500 per month for medications.”

Her daughter “is not stable without medication: it isn’t optional,” Kopacz said. “Why do this to the most vulnerable in our society?”

A revised Senate plan unveiled Thursday represents the latest attempt to deliver on campaign promises to repeal and replace the Affordable Care Act.

Senate Majority Leader Mitch McConnell tweeted the bill “will give Americans more tools for managing their own healthcare, not giving more power to the federal government.”

Though it is far from full ACA repeal, families like Kopacz’s worry about the effects of everything from caps on Medicaid spending curbing hundreds of billions of dollars to proposals that could let insurers opt out of “essential benefits” — and put people with costly conditions in insurance pools that cost them more.

The stakes are highly personal for families affected by mental illness, whether they are among 4 million Floridians covered by Medicaid, 1.5 million with ACA marketplace policies or millions more in employer plans. At the same time, it’s a topic many are not comfortable speaking about publicly.

In what Kopacz called “the scariest day of my life,” doctors at St. Mary’s Medical Center in West Palm Beach saved her daughter’s life after a suicide attempt, she said. Her teenager with bipolar disorder, then 16, was covered by Medicaid. She sees no way the family otherwise could have afforded emergency dialysis and ongoing treatment that cost more than $100,000.

Kopacz said her daughter is “very strong” and “wants her story to help other people.” She suffers from a condition that can run in families and is “not her fault.”

The latest Senate plan provides more money to help states cushion the effects of big changes, but it reduces Medicaid spending by hundreds of billions compared to keeping current law. Medicaid is the largest source of money for public mental health services in the country. Like the House, the Senate plan caps federal money states can receive. Over time, the Senate’s Medicaid savings are forecast to run higher than those in the bill the House passed in May.

The revised Senate bill also could provide a way for insurers to escape Affordable Care Act restrictions about what policies must cover. That means they could charge healthy people less money for plans that are less comprehensive, as long as companies offer at least one ACA-compliant plan. Sen. Ted Cruz, R-Texas, has pitched the concept as promoting consumer choice and bringing down costs.

But a Kaiser Family Foundation study projected “the ACA-compliant plans would effectively become a high-risk pool, attracting enrollees when they need costly health benefits — such as maternity care, or drugs to treat cancer or HIV, or therapies to treat mental health and substance abuse disorders.”

In addition, people ages 50 to 64 and lower-income folks stand to pay more as they receive less generous government subsidies or rules changes let insurers charge them more.

The revised Senate plan would leave some Obamacare taxes in place, risking a backlash from conservative members. States would get more money than in previous versions, including $70 billion to help lower consumer premiums and $45 billion to help treat opioid addiction.

The National Alliance on Mental Illness said it was “deeply disappointed” in the latest Senate effort, saying it contains “severe cuts” to Medicaid. The program covers, among others, 1.75 million U.S. veterans who rely on it for primary and mental health care, the group said.

The Senate bill “will further worsen the mental health crises communities across the country are currently facing in homelessness, suicides, emergency room boarding and burdens on law enforcement,” a NAMI statement said.

Kopacz, the mother of three daughters, worries what coverage will be available to her teen who was hospitalized last year.

“We don’t know what will happen — if she will be booted off Medicaid or will be able to get any other coverage,” Kopacz said.

Medicaid covers about half the childbirths in Florida, disabled people, 70 percent of seniors in nursing homes and 41 percent of Palm Beach County’s children. As children grow into adulthood, they cannot assume they will be covered in Florida’s Medicaid program.

The initial Senate plan would leave 22 million fewer Americans covered by 2026 compared to leaving current law intact, the Congressional Budget Office said. It would create $321 billion in budget savings over a decade, CBO found.

The revised plan is expected to be scored by CBO in coming days, and leaders hope for a vote to proceed within the week — though it’s far from clear they can bridge divisions within GOP Senate ranks, let alone find common ground with the House.

Kopacz spoke Monday in West Palm Beach, across the Intracoastal Waterway from President Donald Trump’s Mar-a-Lago residence, at an event with U.S. Rep. Lois Frankel, D-West Palm Beach.

Republicans want to “take away health care from millions of people,” Frankel said.

Trump said there’s no choice except to act as ACA markets grapple with rising premiums and insurer pullouts. He said in an interview Wednesday with Christian Broadcasting Network founder Pat Robertson that the health care bill “has to get passed.”

Otherwise, Trump said, “it would be very bad” and he will be “very angry about it and a lot of people will be very upset.”

A Kaiser Family Foundation poll released Friday, however, found the replacement plan less popular (28 percent) than the Affordable Care Act (50 percent).

“Things like defunding Medicaid and removing mental health coverage as an essential benefit so insurance plans don’t have to cover it, these might be just politics for some but for families like ours it can literally mean life or death,” Kopacz said. “But you may not hear a lot from people and families vulnerable to these impacts because suicide and mental illness are incredibly difficult to talk about.”

 Trumpcare stakes ‘life or death’ for Boynton mom after teen suicide try