The American Health Care Act’s Rollback of Medicaid Risks Rash of Overdoses in States Hardest Hit by Opioid Crisis

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.”