ACA repeal seen thwarting state addiction efforts

In the three years since the Affordable Care Act took effect, its federally funded expansion of Medicaid to low-income adults has become the states’ most powerful weapon in the battle against the nation’s worsening opioid epidemic.

Now, as Congress and President Donald Trump debate potential replacements for the law, governors, health care professionals and advocates for the poor are cautioning that any cut in federal funding for addiction treatment could reverse much of the progress states have made.

“The current plan to replace the Affordable Care Act would cut health care for our most vulnerable residents, including children, seniors and individuals suffering from opioid and heroin addiction,” Democratic Gov. Tom Wolf of Pennsylvania said last month. “This will have a devastating impact for many Pennsylvanians.”

The Affordable Care Act (ACA) offered states the ability for the first time to provide Medicaid coverage to adults without children, with the federal government paying most of the bill. That change, and the law’s mandate that all insurers cover addiction treatment at the same level as medical and surgical procedures, has allowed states to ensure that lowincome people can get the care they need, said Linda Rosenberg, CEO of the National Council for Behavioral Health, which represents nonprofit addiction treatment organizations.

Since 2014, an estimated 1.6 million uninsured people with addictions have gained Medicaid coverage in the 31 states plus the District of Columbia that opted to expand the federal-state health care program under the ACA. Not all of the newly insured have sought help for their addictions, but treatment providers are reporting a surge in new patients since the law took effect.

In addition, the ACA has provided financial incentives for states to test new models for treatment that streamline care and improve outcomes.

Although a plan for replacing the federal health law has yet to be announced, House Republicans and Trump have proposed shifting Medicaid to a block grant, in which a capped amount of money would be allocated to each state to provide low-income health care services. By putting more of the cost burden on states, the shift is projected to save the federal government $1 trillion over 10 years.

But most states would be unable to come up with the extra money and would have to scale back efforts to get more people into treatment, said Lisa Clemans-Cope, a researcher with the Urban Institute, which analyzes health care policy.

Because addiction is a chronic, lifelong disease, a cut in Medicaid funding would stymie states’ efforts to reduce the number of people who are addicted to heroin and other opioids and at risk for drug overdoses. Not only would lowincome adults already in treatment be in jeopardy of losing coverage for their continuing care, but budget-strapped states likely would be unable to help others get out of homeless shelters and jails and into treatment.

Escalating Epidemic

More than 33,000 people died from opioid overdoses in 2015, a nearly 16 percent increase over 2014. Since 1999, the number of fatal overdoses of prescription drugs such as OxyContin, Vicodin and Percocet, as well as heroin and other illicit drugs, has more than quadrupled.

And the crisis is still raging. Every day 91 people die from an opioid overdose, 3,900 begin abusing prescription painkillers, and 580 people start using heroin.

The ACA and the expansion of Medicaid was a game changer for addiction treatment, Rosenberg said, because it enabled states to reach thousands of new addicts and provide better treatment for them.

Taking it away would be a major setback that could cause the opioid epidemic to worsen, Rosenberg said. “We already have a shortage of trained addiction professionals. Who will want to enter the field if funding is cut?”

Under the ACA, states could expand their Medicaid programs to adults with incomes up to 138 percent of the federal poverty line ($16,394 for an individual). The federal government paid all of the costs to cover newly eligible

Mark Lewis holds a photograph of his 27-year-old son, who died from a heroin overdose, at a conference on the opioid crisis in Salt Lake City. As an overdose epidemic grips the nation, governors are urging Congress and the Trump administration not to...