Obamacare Repeal Deal Risks Making America’s Drug Epidemic Even Worse

A $45 billion Republican opioid addiction plan won’t make up for slashing Medicaid, where most treatment funds come from.
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U.S. Senate Majority Leader Mitch McConnell has been trying to save the foundering Republican effort to replace the Affordable Care Act. One tactic has been to offer funding for combating America’s opioid epidemic, which killed a record 33,000 Americans in 2015. 

The Senate bill unveiled last week would cut Medicaid funding by $772 billion over the next decade, according to the Congressional Budget Office (PDF), Congress’s nonpartisan scorekeeper. As a consolation to wavering Republicans who represent states hit hard by the drug crisis, such as Ohio and West Virginia, McConnell is considering setting aside $45 billion for opioid treatment over the same period.  

The sum won't make up for reductions to the core Medicaid program, according to health experts and state officials.

Medicaid spending on opioid treatments has increased sharply in tandem with the widening epidemic. Payments for three drugs used to treat addiction and reverse overdoses—buprenorphine, naltrexone, and naloxone—jumped to $930 million last year, from $394 million in 2011, according to a new analysis (PDF) from the Urban Institute. The study didn’t count spending on methadone, another common addiction treatment, because data weren’t available, so the true total is higher.

“It would be very difficult to set a cap on what kind of treatment level is going to be needed say, next year, or the year after that,” said Lisa Clemans-Cope, a health economist who co-authored the report.

And that’s just for medication to help people with opioid addiction. What isn’t tallied is the cost of counseling or other services. All told, Medicaid spent about $7.9 billion on treating substance abuse just in 2014, according to an analysis published in Health Affairs that year. 

Under the Senate Obamacare repeal, about 4 million people who would otherwise have been covered by Medicaid would become uninsured next year, the CBO estimates. The number would rise to 15 million in 2026. Currently, Medicaid covers 72 million Americans each year.

The need for opioid addiction treatment, meanwhile, already far outstrips availability. About 2.3 million people abused opioids in 2012, but the maximum capacity for medication-assisted treatment was 1.4 million, according to a Government Accountability Office report (PDF) last year.

In Ohio, where 3,050 people died from drug overdoses (PDF) in 2015, the Senate health-care bill plan “would have a very negative impact on our ability to fight both the opioid issue and also mental health issues,” said Barbara Sears, director of the state’s Medicaid program.

Since Ohio expanded Medicaid under Obamacare in 2014, about half of new enrollees have gotten treatment for mental health or substance abuse. Sears said a bucket of opioid money wouldn’t make up for the loss of Medicaid funds.

“We really are looking at the entire person,” she said. “Just putting dollars toward the issue itself doesn’t really take into account the fact most people with addiction problems have other things going on in their lives.”

Even if the Obamacare replacement plan had adequate funding for drug abuse, people would still suffer from Medicaid cuts, said Richard Frank, a Harvard health economist who worked in the Obama administration. “Just giving them [addiction] treatment but not taking care of their HIV, or their hepatitis C, or their hypertension, that’s going to kill them too,” Frank said.

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