Immediate Action Needed 

Contact the senators who represent your state to oppose onerous changes to the Medicaid and Affordable Care Act (ACA) programs under consideration by the U.S. Senate. Millions of Americans who rely on Medicaid and the ACA for their mental health services could lose access to essential care.  

The Situation 

The U.S. House of Representatives has passed legislation—the One Big Beautiful Bill Act (H.R. 1)—that will significantly reduce the number of people who receive health insurance coverage through the Medicaid and CA programs. The Senate is now considering this legislation that creates significant barriers to obtaining and maintaining health insurance through both Medicaid and ACA programs. The action threatens significant losses in mental health coverage, endangering both client care and provider viability.  

The bill mandates that able-bodied adults without disabilities must meet monthly requirements of 80 hours of work, volunteer service, or educational activities to qualify for coverage. Unfortunately, evidence from the few state programs that have used this strategy shows that, instead of promoting job growth, these requirements primarily serve as administrative obstacles that ultimately lead to coverage loss. The Congressional Budget Office has estimated that nearly 8 million eligible individuals may lose their Medicaid health insurance because of administrative red tape. 

Additionally, the House chose not to renew enhanced premium subsidies that currently make ACA marketplace plans affordable for many lower-income Americans. When these subsidies lapse in December, insurance costs are projected to surge dramatically, potentially forcing numerous enrollees to abandon their health coverage. The legislation also creates enrollment barriers, which, when combined with the loss of premium subsidies, could result in an additional 6 million Americans losing their ACA marketplace coverage. 

What’s at Stake 

Nearly 15 million Americans facing the loss of their health insurance would have critical consequences: 

• Clinical Catastrophe: Clients may face severed access to counselors, continuity of care, and life-saving medications. 
• Provider Exodus: Mental health practices in underserved communities could be forced to close their doors. 
• Impossible Trade-offs: Families could face devastating choices between paying for counseling sessions or covering basic needs. 

Potential Impacts 

For Counselors: 

• financial instability as reimbursement structures collapse 
• overwhelming paperwork replacing patient care time 
• difficult decisions about practice viability and community service 

For Clients: 

• abrupt termination of therapeutic relationships built over months or years 
• return to emergency rooms as the only remaining mental health resource 
• increased risk of hospitalization, homelessness, and crisis situations 

Take Action Now 

1. Contact your senators immediately. 
2. State your opposition to Medicaid work requirements and barriers to enrolling in the Affordable Care Act.  
3. Share how these actions and the loss of health insurance would affect your practice and clients.