Trump would cut opioid insurance protections
WASHINGTON — A year after President Donald Trump called for a public health emergency to control the opioid crisis, the administration is working to roll back health insurance coverage that public health experts say is critical to reining in an epidemic that killed nearly 50,000 Americans in 2017.
The White House is calling — in its 2019 budget — for more than $1 trillion in cuts over the next decade in federal aid to state Medicaid programs, which are a leading source of insurance coverage for people suffering from addiction.
The Justice Department is backing a sweeping legal challenge to the Affordable Care Act that would eliminate a requirement in the law that insurers cover people with preexisting medical conditions. That would effectively allow insurers to once again deny coverage to people seeking addiction treatment.
And just this week, the Trump administration took new steps to loosen rules on commercial health insurers to allow for skimpier health plans that don’t have to cover a full range of benefits, including treatment for substance use disorders such as opioid addiction.
“What has really worked here is Medicaid expansion,” said Linda Rosenberg, president of the National Council for Behavioral Health. “Yet this administration is continually attacking entitlements because of the deficit. That really concerns us.”
The Trump administration’s health insurance moves come amid some promising signs that the sharp increase in opioid overdose deaths in recent years may be slowing. Preliminary data reported by the Centers for Disease Control and Prevention suggest that the number of deaths flattened in late 2017 and early 2018.
At the same time, lawmakers from both parties were at the White House on Wednesday to celebrate a large opioid bill they passed earlier this fall.
But rolling back insurance coverage or weakening rules on health plans threaten to undercut public health initiatives around the country to boost treatment, according to health care leaders.
“The expansion of Medicaid covered more people, and those people are accessing addiction treatment,” said Dr. Kelly J. Clark, president of the American Society of Addiction Medicine. “Prior to that, they simply weren’t able to.”
Clark works in Kentucky, which expanded Medicaid coverage through the 2010 health care law, often called “Obamacare.” Medicaid expansion has allowed states to extend coverage to millions of previously uninsured working-age adults, many of whom suffer from substance use disorders.
The program is now the largest source of funding for treatment of behavioral health, including substance use disorder.
Medicaid, which insures some 70 million low-income Americans, historically covered primarily poor children, pregnant mothers and the lowincome elderly — populations that have not been as affected by the opioid epidemic.