Advocates Warn Congress: Stop Playing Politics or People Will Die
Washington, DC—(ENEWSPF)—March 20, 2017. Repeal of the Affordable Care Act (ACA) would have a devastating impact on the millions of people in this country currently struggling with problematic substance use and would exacerbate the worst drug overdose crisis in U.S. history.
It is accordingly imperative that any replacement health care bill in Congress does not affect 1.) the continued expansion of Medicaid as well as Medicaid coverage of mental health and substance use treatment and 2.) the requirement that public and private insurers provide coverage for some form of substance abuse treatment at parity with medical and surgical services. These provisions have provided profound and necessary health benefits to people in the U.S. who struggle with substance use and overdose risk, but these benefits are in jeopardy if the Republican-backed American Health Care Act is approved.
“Rolling back the expansion of Medicaid threatens to snuff out treatment access in communities hardest hit by the opioid crisis and snuff out lives to overdose as well,” said Grant Smith, deputy director of national affairs with the Drug Policy Alliance. “The American Health Care Act takes treatment away from millions who need it. If enacted it would worsen the opioid crisis and harm public health and safety.”
The expansion of Medicaid under the ACA has meant that more people are covered by insurance, more behavioral health services (including medication-assisted treatment) are available, and more people exiting jail and prison have access to substance use treatment. Indeed, the Medicaid expansion and implementation of ACA health exchanges provided roughly two million people who struggle with addiction—a third of them opioid users—coverage that they did not have previously. It also helped states hit hardest by the opioid crisis, including Ohio, Kentucky, and West Virginia, provide coverage to their low-income residents who were previously ineligible for Medicaid coverage.
Unfortunately for this already vulnerable population, the American Health Care Act would suspend the expansion of Medicaid by 2020, and pull coverage from an estimated 1.3 million low-income people with behavioral health needs. It would also eliminate a key provision in the ACA that mandates that Medicaid cover mental-health and substance use treatment coverage in states that expanded it. The result will be a reversion to inadequate coverage and care for the most marginalized among us. Coupled with the current opioid crisis, however, the result will be catastrophic.
These rollbacks would likely end coverage for medication-assisted treatment for people who are currently covered since many states will opt not to shoulder the cost of continuing to provide these services without a federal mandate to do so. Medications like methadone and buprenorphine are critical to stemming the opioid crisis, but people who rely on Medicaid are likely not going to be able to afford the out of pocket costs for this life saving treatment. Without adequate coverage to access treatment and health care, people struggling with problematic substance use could relapse to riskier opioid and other drug use behaviors that increase risk for developing costly medical conditions, contracting and transmitting blood borne disease, and experiencing life threatening overdose.
The Drug Policy Alliance strongly urges Congress to reject the American Health Care Act because it threatens to undermine the expansion and funding of Medicaid and undercut the provision of insurance coverage for substance use treatment on par with other medical services. People are already dying at alarming rates from problematic substance use and overdose; a suspension in services and treatment is a veritable death sentence for the millions of people who would be without coverage and access.
“Rolling back the expansion of Medicaid would undermine President Trump’s repeated pledge to expand treatment access,” said Emily Kaltenbach, senior director, criminal justice reform strategies with the Drug Policy Alliance. “Congress and President Trump must ensure any health care bill expands drug treatment and overdose prevention for people who need it.”
The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide.
Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.
The proposal would also roll back the Medicaid expansion under the act — commonly known as Obamacare — which would affect many states bearing the brunt of the opiate crisis, including Ohio, Kentucky and West Virginia. Thirty-one states and the District of Columbia expanded Medicaid under the ACA.
“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” said Joshua Sharfstein, associate dean at Johns Hopkins Medical School.
Advocates and others stress that mental-health disorders sometimes fuel drug addiction, making both benefits essential to combating the opioid crisis.
Nearly 1.3 million people receive treatment for mental-health and substance abuse disorders under the Medicaid expansion, according to an estimate by health care economists Richard G. Frank of the Harvard Medical School and Sherry Glied of New York University.
House Republicans confirmed the benefit cuts during a meeting of the House Energy and Commerce Committee on Wednesday. Republicans on the committee argue that the change would give states additional flexibility in coverage decisions, and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed.
During the committee meeting, Rep. Joe Kennedy (D-Mass.) asked a GOP staffer whether those benefits are “no longer essentially covered, or required to be covered, by this version of this text. Is that not correct?”
“The text before us does remove the application of the essential health benefits for the alternative benefit plans in Medicaid,” a lawyer for Republicans on the committee responded.
“Including mental health?”
Rep. Joe Kennedy (D-Mass.) said he and Rep. Peter Welch (D-Vt.) introduced an amendment during the committee meeting to include mandates for substance abuse and mental-health coverage, but it was voted down along party lines.
Several Republican senators expressed concern about removing the benefits. Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.) stating that the plan does not “provide stability and certainty” for individuals and families enrolled in Medicaid expansion programs, or flexibility for states.
President Trump has made combating the nation’s drug-overdose problem a focal point of his campaign and his presidency.
“We will stop the drugs from pouring into our country and poisoning our youth,” he said in a speech before Congress last week, “and we will expand treatment for those who have become so badly addicted.”
Trump has endorsed the Republican plan to replace the ACA.
A record number of people — 33,000 — died of opiate overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioids now kill more people than car accidents, and in 2015 the number of heroin deaths nationwide surpassed the number of deaths from gun-related homicides. Authorities are also grappling with an influx of powerful synthetic narcotics responsible for a sharp increase in overdoses and deaths over the past year.
The 15 counties with the highest death rates from opiate overdoses were in Kentucky and West Virginia, according to a group of public health researchers, writing in the New England Journal of Medicine. Both of those states expanded Medicaid. Taking away those benefits, they wrote, would affect tens of thousands of rural Americans “in the midst of an escalating epidemic.”
Medicaid pays for 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia and 44 percent in Kentucky when the drug buprenorphine, which is used to manage chronic opiate use disorder, is administered, according to Rebecca Farley, vice president of policy at the National Council for Behavioral Health.
Public health officials and advocates say there is a nationwide shortage of treatment programs to serve the growing problem of addiction and its effects, including diseases associated with long-term IV drug use such as hepatitis C and HIV.
Shawn Ryan, a doctor with Brightview Health in Cincinnati, which provides addiction treatment mainly to patients on Medicaid, said states are starting to increase drug addiction services to respond to rising needs, but the process could take years.
“The outpatient addiction treatment services that are starting to ramp up . . . they could be crushed by this if not done in a way that specifically protects the most vulnerable populations,” he said.
Stripping away addiction treatment services from low-income people is especially harmful, Frank, of Harvard, said in an interview, because the prevalence of drug abuse is much higher for people living well below the poverty line. He said Medicaid recipients who are covered for addiction treatment and maintain their coverage through 2020 would not lose the benefit under the GOP proposal. But, he added, because addiction is a chronic-relapse disease, people may get clean, relapse, stop working and need to go back on Medicaid.
“It’s a disease that hits suddenly at various points in the life cycle,” Frank said.
Some GOP lawmakers advocate a full repeal of the ACA, a move that would result in loss of coverage for 2.8 million people, 222,000 of whom have an opioid disorder, Frank and Glied, of NYU, estimate.
Gary Mendell, founder of the anti-addiction organization Shatterproof, said the group plans to run campaigns against the rollback in eight states where Medicaid was expanded, urging people to contact their elected officials. Mendell, whose son battled addiction and died in 2011, said the drug-abuse battle has transcended party lines. Last year, Congress passed a landmark bill to fight opiate addiction.
“It’s been a bipartisan effort to attack the opiate epidemic,” he said, “and now Republicans are putting fighting the opiate epidemic in the back seat to politics.”
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