Obamacare Repeal Could Be a Big Setback for the Fight Against Addiction
Policy + Politics

Obamacare Repeal Could Be a Big Setback for the Fight Against Addiction


Should the Republicans eventually make good on their threat to dismantle the Affordable Care Act, several million Americans being treated for opioid addiction and serious mental disorders likely would lose their Medicaid coverage, according to a new study.

The Medicaid program for low income adults and children, pregnant women and disabled people was substantially expanded under Obamacare in 32 states and the District of Columbia. As a result, hundreds of thousands of more low income adults with substance abuse problems gained coverage.

Related: US Death Rate From Heroin and Opioid Abuse Soars

Overall, millions of people qualified for the first time for mental health and drug addiction treatment programs through expanded Medicaid, their employer health insurance or other private market plans, thanks to provisions of the Affordable Care Act.

While the fate of the expanded Medicaid program is very much up in the air as President Trump and Republican congressional leaders struggle to come up with a replacement for Obamacare, a new study by the liberal leaning Center on Budget and Policy Priorities warns that 4.1 million people are at risk of losing their mental health and drug addiction coverage.

Those include 1.3 million people with serious mental illness and 2.8 million people with opioid and other substance abuse disorders. Health care economists Richard G. Frank and Sherry A. Glied prepared the estimates for the center.

The need for treatment of addiction to prescription drugs, heroin and other opioids couldn’t be greater.

Related: As Heroin Addiction Surges, Obama Orders New Treatments

In 2015, nearly 94 million people reported using illicit drugs, misusing prescription drugs or binge drinking, according to a report by the U.S. Surgeon General. The nationwide epidemic of opioid and heroin abuse, in up-scales suburban communities as well as urban areas, surfaced in the 2016 presidential campaign and was decried by President Trump.

Last October in New Hampshire, Trump vowed to crack down on prescription drug abuse while offering help to those struggling with addiction. Specifically, he promised to “dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment.”

There were a record 47,000 drug overdose deaths in 2014, with 29,000 or 61 percent, stemming from opioid use. Nineteen states in all regions of the country – especially West Virginia, Kentucky and New Hampshire -- saw a statistically significant increase in drug overdose deaths between 2014 and 2015, according to the Centers for Disease Control and Prevention..

Related: The Rapidly Rising Death Toll of the Heroin Epidemic

Even more shocking, deaths from heroin overdoses rose by 23 percent in 2015 to 12,990, for the first time surpassing deaths from gun violence in the United States.

According to the new report, the ACA, in tandem with the 2008 Mental Health Parity and Addition Equity Act, made “huge advances in improving and ensuring treatment” for people with drug addiction problems. The changes in the law made treatment more available and less expensive. Also, young people who needed help could stay on their parent’s health plans up to age 26.

What’s more, the new laws recognized that mental health and substance abuse treatments are just as important as physical conditions, and that it would be a mistake to impose more restrictions on the number of treatment sessions for these mental health disorders than for more typical visits to doctors and health care facilities.

Republican and Democratic governors alike have raised concern about losing expanded Medicaid coverage for their constituents if the Affordable Care Act is finally repealed – or if Congress converts the Medicaid program to federal block grants to the states. State and local government’s share of overall substance abuse treatment spending fell from 35 percent to 29 percent between 2007 and 2014, according to the new report.

Related: The New War on Heroin Has Only Just Begun

“ACA repeal would put pressure on states and localities to raise funding for substance use services, likely forcing them to stop paying for non-Medicaid eligible support services that assist in [substance abuse] recovery, such as housing and employment training,” the report said. “And states could no longer afford to test new models of treatment or recovery supports.”