Just before the end of December, when people were shutting off their news feeds and setting up their out-of-office emails, advocates in Arizona held a press event to highlight the devastating impact the repeal of the Affordable Care Act (ACA) would have on children in foster care in the state. Thanks to the ACA, many parents have health coverage, including access to substance use treatment and behavioral health services, for the first time. These services are at the front line of prevention, supporting parents in caring for their children. If Congress chooses to repeal the ACA without offering a more robust, accessible vehicle for health service, these parents will lose access to important, needed services.

Arizona advocates put key decision makers on notice that repeal of the ACA could lead to an increased number of children being removed from families following reunification because parents will lose access to vital behavioral services and supports. Preventing children from entering into a cycle of foster care means providing needed services and support to parents, ranging from substance use treatment and mental health services to parent coaching and housing support. The ACA is a vital part of the prevention framework – enabling families to access important health services before a crisis hits.

While the ACA provides new and important access to behavioral health services for consumers, there are benefits beyond the human side of helping those in need that states see. States that expand Medicaid can incur increases in efficiency in their behavioral health programs without incurring additional costs; extending coverage to a new set of consumers can free up state dollars to provide health adjacent services – such as housing and employment support – that can improve health outcomes. Evidence shows that access to Medicaid can improve local economies by addressing the behavioral health needs that may keep people from working or engaging with their communities. In addition, treating behavioral health conditions reduces disability and decreases criminal justice costs. For children at risk of entering the foster care system, the ACA provides necessary supports to them through their parents. The ACA is an important tool needed to keep families strong.

As Congress contemplates repeal of the ACA without a clear plan to support the millions of parents and their children across the country, advocates should highlight the multitude of shockwaves that would ripple through the system. As articulated by Dana Naimark from Children’s Action Alliance in Arizona: “It would be like promising we are going to tear down an old building and replace it with a shiny new tower, do the demolition and leave the ugly and dangerous rubble for two years or three years before any new construction gets started.”  

The foster care system is one of many that is inextricably linked to the health care system. Parents who struggle with caring for their children may require access to health services in order to step back into the role of caregiver and nurturer. Without the ACA, many parents will lose access to important behavioral health services – and the victims of the unraveling of these prevention systems will be children.