The health care bill released by Senate Republicans on Thursday is stoking outrage among mental health and addiction groups for its proposed steep cuts to Medicaid, the government’s largest health insurance program. Medicaid is the single largest payer for mental health services in the United States and provides coverage for millions of Americans with mental health or substance abuse disorders.

The proposed change is especially painful for these organizations because they saw an expansion of mental health coverage under the Affordable Care Act. After it was enacted, an estimated 2.8 million Americans with substance use disorders and 1.3 million with serious mental illness gained health insurance coverage for the first time under Medicaid expansion. In some states, Medicaid programs cover more than 40% of prescriptions of buprenorphine, a drug that treats opioid addiction.

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