GOP health-care bill would drop addiction treatment mandate covering 1.3 million Americans

GOP health-care bill would drop addiction treatment mandate covering 1.3 million Americans

By Katie Zezima and Christopher Ingraham, Washington Post, March 9 

The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment as the number of people dying from opiate overdoses is skyrocketing nationwide.

Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.

The proposal would also roll back the Medicaid expansion under the act — commonly known as Obamacare — which would affect many states bearing the brunt of the opiate crisis, including Ohio, Kentucky and West Virginia. Thirty-one states and the District of Columbia expanded Medicaid under the ACA.

“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” said Joshua Sharfstein, associate dean at Johns Hopkins Bloomberg School of Public Health.
Advocates and others stress that mental-health disorders sometimes fuel drug addiction, making both benefits essential to combating the opioid crisis.

Nearly 1.3 million people receive treatment for mental-health and substance abuse disorders under the Medicaid expansion, according to an estimate by health care economists Richard G. Frank of the Harvard Medical School and Sherry Glied of New York University.

House Republicans confirmed the benefit cuts during a meeting of the House Energy and Commerce Committee on Wednesday. Republicans on the committee argue that the change would give states additional flexibility in coverage decisions, and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed.

During the committee meeting, Rep. Joe Kennedy (D-Mass.) asked a GOP staffer whether those benefits are “no longer essentially covered, or required to be covered, by this version of this text. Is that not correct?”

“The text before us does remove the application of the essential health benefits for the alternative benefit plans in Medicaid,” a lawyer for Republicans on the committee responded.

“Including mental health?”

“Yes.”

Rep. Joe Kennedy (D-Mass.) said he and Rep. Peter Welch (D-Vt.) introduced an amendment during the committee meeting to include mandates for substance abuse and mental-health coverage, but it was voted down along party lines.

Several Republican senators expressed concern about removing the benefits. Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.) stating that the plan does not “provide stability and certainty” for individuals and families enrolled in Medicaid expansion programs, or flexibility for states.

President Trump has made combating the nation’s drug-overdose problem a focal point of his campaign and his presidency.
“We will stop the drugs from pouring into our country and poisoning our youth,” he said in a speech before Congress last week, “and we will expand treatment for those who have become so badly addicted.”

Trump has endorsed the Republican plan to replace the ACA.

A record number of people — 33,000 — died of opiate overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioids now kill more people than car accidents, and in 2015 the number of heroin deaths nationwide surpassed the number of deaths from gun-related homicides. Authorities are also grappling with an influx of powerful synthetic narcotics responsible for a sharp increase in overdoses and deaths over the past year.

The 15 counties with the highest death rates from opiate overdoses were in Kentucky and West Virginia, according to a group of public health researchers, writing in the New England Journal of Medicine. Both of those states expanded Medicaid. Taking away those benefits, they wrote, would affect tens of thousands of rural Americans “in the midst of an escalating epidemic.”

Medicaid pays for 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia and 44 percent in Kentucky when the drug buprenorphine, which is used to manage chronic opiate use disorder, is administered, according to Rebecca Farley, vice president of policy at the National Council for Behavioral Health.