WASHINGTON — Advocates for drug addiction services say the House Republican health care proposal could dramatically shrink access to treatment at a time when the country remains in the grip of an opioid epidemic.
“The bill that they’re proposing is going to be catastrophic for states’ abilities to fight the overdose crisis,” said Daniel Raymond, policy director of the Harm Reduction Coalition, a national advocacy organization for people with mental health and addiction diseases.
Republicans defended the measure, saying it keeps in place many of the protections enacted under the Affordable Care Act.
“Our plan will not pull the rug out from anyone,” said Rep. Pat Tiberi, R-Ohio, who helped craft the bill.
The House bill — which could come up for a floor vote in the coming weeks — is the GOP’s alternative to the ACA, or Obamacare, the 2010 law Republicans have vowed to repeal.
GOP lawmakers say the ACA is an expensive, burdensome law that has failed to control spiraling health care costs and imposed stifling regulations on businesses and insurers. Democrats say the law has protected patients from discriminatory insurance practices and greatly expanded access to coverage. An estimated 20 million Americans have gained coverage since the law’s enactment.
Among those helped the most by the ACA: Lower-income adults aged 25 to 45 — a segment of the population that has also been heavily hurt by the opioid epidemic.
Patients suffering from addiction have been able to take advantage of the law’s Medicaid expansion, the joint federal-state health care program for the poor and disabled. The ACA allowed states to expand coverage to those earning less than 138% of the federal poverty level.
Nearly 30% of those who got coverage through the Medicaid expansion suffer from a mental disease or an addiction to substances, such as opioids or alcohol, according to the federal Substance Abuse and Mental Health Services Administration.
In the 31 states (plus the District of Columbia) that expanded Medicaid, the program now covers 27% of all addiction treatment, said Lindsey Vuolo, associate director of health law and policy at the National Center on Addiction and Substance Abuse. And for those suffering from opioid addiction, Medicaid now covers 35% to 50% of the cost of “medication-assisted treatment,” a highly effective regimen.
The House Republican bill would freeze the Medicaid expansion in 2020; it would also cap payments to the states for all beneficiaries.
Those steps could significantly trim participation in the program and make it more expensive for states to cover poor residents — possibly forcing states to restrict eligibility.
“What they’re proposing impacts people with mental illness and addiction more than any other disease category,” said Linda Rosenberg, president and CEO of the National Council for Behavioral Health. That's because people with mental illness and addiction are often driven into poverty due to their illnesses, she said, so they rely on Medicaid for their health care more than other Americans.
Defenders of the House GOP bill note that it does not kick patients off of Medicaid expansion — it just limits future enrollment. And Republican lawmakers argue that the Medicaid program is fiscally unsustainable in its current form.
“We need to put Medicaid on a more sustainable budget that ensures states can care for the most vulnerable over the long-term, including for those suffering from addiction,” said Olivia Hnat, a spokeswoman for Tiberi. “On its current fiscal path, Medicaid spending will be larger than our nation's defense budget by 2018. By 2026, total Medicaid spending is projected to be $1 trillion.”
Hnat said the House GOP bill’s per-capita payment proposal will give states flexibility to manage costs, without jeopardizing care “for people who rely on this program.”
But advocates note that individuals on Medicaid have irregular incomes, which means they cycle on and off the program frequently as their job situations change. Under the GOP bill, if a person drops off Medicaid, the expanded eligibility would be closed to them come Jan. 1, 2020.
“If we weaken the Medicaid system at all, it’s going to make it impossible to turn this (epidemic) around. Impossible,” said Dr. Jeremy Engel of St. Elizabeth Family Physicians in Northern Kentucky.
“With Medicaid, there is a chance of recovery and highly functional individuals,” Engel said. Without the strengthened Medicaid program, he said, “we might as well give up.”