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While President Donald Trump, Speaker Paul Ryan and the GOP majority failed to muster a vote on the legislation to repeal and replace the Affordable Care Act, supporters have won a battle. But the war rages on.

Trump now has an opportunity to exercise a presidential moment to work with Democrats and Republicans to repair the law in ways that help the American people and can win bipartisan support. Our government can positively or negatively affect millions of lives.

Let us consider what’s at stake if cuts are made to Medicaid and Obamacare in Michigan, and more specifically in the tri-county region of Oakland, Macomb and Wayne counties.

Nearly 300,000 Healthy Michigan/Affordable Care Act enrollees (182,000 in Wayne, 55,000 in Oakland, and 44,000 in Macomb) in the metro region will lose access to health care by the year 2020 under the Republican plan.

The American Health Care Act would have stripped needed health benefits from vulnerable people. After its recent failure in Congress, the American people can only hope that whatever it is replaced with will put their needs first. The nonpartisan Congressional Budget Office came out with estimates that the American Health Care Act would have resulted in 26 million less people being insured nationally by 2026.

The Affordable Care Act serves 660,000 people in Michigan who would be at risk of losing their health care insurance benefits with changes to it. In general, poor children, the elderly, and persons with disabilities would be disproportionally affected by its changes. Nationally, Medicaid insures 30 million children. In Michigan, 54.9 percent of individuals on Medicaid are children.

As Congress reshapes its plan in the best interest of the American people it should ensure ongoing support and the financing of Medicaid expansion with a federal match rate that is sustainable for the states. Many states depend on this supplemental income to offset health insurance costs for this vulnerable population who live just over the federal poverty line. They should commit to maintaining the mandate that mental health, substance use and prevention services are indeed health care and should therefore be included in all health plans as an essential benefit.

In the metro region alone if funding were cut, the state of Michigan would need to allocate an additional $112 million to ensure there is no disruption in services for more than 31,000 persons with severe and persistent mental illness, intellectual, or developmental disabilities, and substance use disorders — some with all three. All of these individuals are currently receiving services funded by Healthy Michigan.

The repeal and replace plan would have removed the requirements that Medicaid include vital mental health and substance use services, and that these services receive the same parity as provided for physical health care. This threat comes in the midst of what is being called the worst drug crisis of all time. In 2015 more than 33,000 Americans tragically lost their lives to the opioid epidemic.

It is estimated that approximately 60 percent of the population in county jails and state prisons have a mental illness. Reduced mental health and substance use care will only increase the numbers in our criminal justice system. This is a terrible injustice to them and a tremendous expense to taxpayers.

The Healthy Michigan Plan has reduced the number of people who were utilizing the emergency room for their physical and mental health care. Many of these individuals are now receiving timely preventive care in their physicians’ office. If people covered by the plan lose this valuable insurance benefit, preventive services will again be replaced with emergency room visits or left untreated.

We urge Congress to listen to governors, like Gov. Rick Snyder, to retain health care for our most vulnerable citizens, persons with serious mental illness, children with emotional disturbances, individuals with intellectual and developmental disabilities, and persons with substance use disorders.

Congress should safeguard insurance benefits for individuals with disabilities, and identify them as the priority group for any changes in the health care legislation. It should also worry that stripping the poor and persons with disabilities of health care is unhealthy for our state and nation, and it should seek sensible reforms that will help keep Michiganians and Americans healthy.

Tom Watkins is president and CEO of the Detroit Wayne Mental Health Authority. Willie Brooks is executive director and CEO of the Oakland County Community Mental Health Authority. John Kinch is executive director of the Macomb County Community Mental Health Authority.

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