Medicaid rollback idea shortsighted

Reducing treatment for people struggling with addiction would threaten lives of thousands

Repeal of the Affordable Care Act would have a devastating impact on New Mexico and the tens of thousands of people in our state currently struggling with problematic substance use. An impending decision by the Senate could exacerbate the decadeslong drug overdose crisis in New Mexico.

What we know about the House-passed American Health Care Act is that it proposes to roll back Medicaid expansion and raise costs on those with pre-existing conditions, among other very significant changes. The Senate Republicans, behind closed doors, are drafting their own bill. Bill provisions are shrouded in secrecy, but we can only (imagine) that it, too, will roll back Medicaid.

President Trump and Congress have repeatedly pledged to expand treatment access, but supporting the rollback of Medicaid expansion goes completely counter to their promises. Indeed, the Medicaid expansion and implementation of ACA health exchanges provided roughly two million Americans who struggle with addiction — a third of them opioid users — coverage that they did not have previously. These are the people who are at risk of fatal overdoses if Congress approves a bill that guts Medicaid.

An issue brief from the Kaiser Family Foundation lists New Mexico as one of 11 states that will be hardest hit by repealing and replacing the ACA. Kaiser states that New Mexico “cannot cope with reductions in federal Medicaid funding of the sort proposed.”

The expansion of Medicaid under the ACA has meant that more people in New Mexico are covered by insurance, more behavioral health services — including medication-assisted treatment such as methadone and buprenorphine — are available, and more people exiting jail and prison have access to substance-use treatment.

But the rollbacks would likely end coverage for buprenorphine and methadone treatment for people who are currently covered, since New Mexico will likely opt not to shoulder the cost of continuing to provide these services without a federal mandate to do so. These medications 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 result will be catastrophic — a veritable death sentence for thousands of New Mexicans.