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President Donald Trump and the Republican-led Congress are poised to gut the Affordable Care Act. Nearly 30 million people, including 4 million children, could be deprived of health care cov erage by 2019. Many have rallied against the loss of reproductive health care and other services, and should continue to do so. But less attention has been given to the millions of Americans who suffer from mental illness, or struggle with substance misuse or addiction.

Services for mental illness and substance misuse have been severely underfunded and ignored for decades. The Affordable Care Act was an important first step forward to make sure there is as much coverage for mental health as there is for physical health.

Under the ACA, insurance companies are obligated to cover mental health care the same way they cover physical health care – in fact, mental health and addiction benefits are considered “essential” under the ACA. That means talk therapy or a prescription to treat depression or opioid addiction gets the same coverage as a physical therapy appointment or an antibiotic. Just as important, the ACA provides coverage for preventive services, like screenings, so people can get help before they get really sick.

Given that 1 in 5 Americans suffers from a mental health or substance misuse problem, we are all affected by the lack of parity and equity with physical conditions like asthma or diabetes, and we all have a stake in preserving access to care.

Without the ACA, coverage of mental health problems could evaporate. Even worse, many of the Americans affected would struggle to find alternatives. The ACA expanded access to poor and working-class Americans. These are families with an income of less than $26,500 a year. Millions of Americans will have to choose between putting food on the table, or treating their mental health or substance misuse problems.

That’s a devastating choice for a family. Without mental health care, work, relationships, and schooling get much harder. And when one family member suffers, so does the entire family.

When I was growing up, both of my parents suffered from depression, which of course affected my life and my emotional development. And over the years, I have noted that many people close to me — members of my extended family, friends, and coworkers — suffered from alcoholism, bipolar disorder, PTSD, schizophrenia, and other conditions, some diagnosed and treated, and some not.

I know the emotional frustration and anxiety that accompany unexplained and erratic behaviors when loved ones don’t get the care they need. And I know how suicide can haunt a family for years with questions, spoken and unspoken, that never go away.

A few years ago, our daughter was diagnosed with depression and anxiety. And it was so difficult to find appropriate services that I could not imagine how families with fewer resources were able to manage everything. Her struggle and success helped me decide that our society has to do more to help all of our families.

Repealing the ACA, and the mental health care it provides, could not come at a worse time.

Our country has an opioid crisis that kills thousands of people a year. Disinvestment in mental health, alongside with the already existing challenges of accessing affordable treatment, will place far too many people at risk for death. Without adequate care, our jails and prisons will see even more people with mental illness and substance misuse problems come through their doors.

If the Affordable Care Act is repealed, the mental health support so many people need to work, parent, get an education, and maintain healthy relationships will disappear, along with many other benefits.

But we don’t have to be fearful or discouraged.

One of the reasons I wanted to write about the Affordable Care Act (aka Obamacare) for Cosmo is that I know I’m speaking to readers who get it. Women don’t let politics get in the way of helping our families and friends. We have a lot on our plates, but it is most important for us to take care of our loved ones.

If you want to protect the Affordable Care Act, please call your congressional representatives and tell them to mend the ACA; don’t end it. Tell them to defend the life-saving reforms in the Affordable Care Act.

I know we can do better than leaving millions of families unprotected. Just before the inauguration, I was in Washington, D.C., talking to members of Congress about our efforts to improve mental health care in New York City with ThriveNYC, our $850 million effort to reform mental health care in our city. So many of them — on both of sides of the aisle — get it. They’ve seen the toll that untreated mental illness or substance misuse can take with their own families. And they want to do the right thing. But they need to hear from you.

So please, take action. Together, we can send a message to Congress and to President Trump that there is no health without mental health. And we demand affordable health care for our families and communities.

First lady Chirlane McCray is the driving force behind ThriveNYC, the city’s $850 million action plan to change the way New Yorkers think about mental health, and the way government and its partners deliver services. McCray also leads the Cities Thrive coalition of more than 130 mayors from across the country committed to local and federal mental health reform.

Follow Chirlane on Twitter.

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