The American Health Care Act, the House Republican's Affordable Care Act replacement plan released Monday, would worsen the opioid epidemic, Keith Humphreys, PhD, a Stanford professor of psychiatry and behavioral sciences, and colleagues say.
"The House bill introduced Monday would remove substance use disorder treatment coverage as an essential health care benefit in Medicaid beginning in 2020," Humphreys, a drug policy expert, wrote me in an email. "This would have devastating consequences for access to care in states like West Virginia, Kentucky and Ohio, which have used Medicaid expansion to provide much-needed treatment for addiction."
In an opinion piece published in the New England Journal of Medicine today, Humphreys and co-authors call for President Trump to fulfill his campaign pledge to respond to the opioid epidemic. The piece states:
In an October 2016 speech [President Trump] delivered in New Hampshire, another state hit hard by opioid addiction, he said that he 'would dramatically expand access to treatment slots' and 'help all of those people so seriously addicted get the assistance they need to unchain themselves.'
Rural communities would be affected the most by the repeal of the ACA, areas that have also been hardest hit by the opioid crisis and are most dependent on expanded Medicaid coverage, Humphreys said. The authors wrote:
In 2015, the 15 counties with the highest mortality from opioid-related overdose were all predominantly rural, and almost all were located in Kentucky and West Virginia — both states that have expanded Medicaid. Repeal would abruptly reverse the dramatic insurance expansions that have occurred in these and other states, revoking coverage for medication treatment for tens of thousands of rural Americans with opioid use disorders in the midst of an escalating epidemic.
The proposed legislation and repeal of the ACA would also reduce access to addiction treatment for those with private insurance, Humphreys said. He explained in an email: "Because most addiction treatment is provided in small, single-mission agencies that work on a tight margin, these cuts would also reduce care for the non-Medicaid population by bankrupting many agencies that take care of both Medicaid and privately insured addicted patients."
In closing, the authors urge policymakers to work together to address the crisis:
The opioid epidemic cuts across the lines of political polarization, touching nearly every community in this country. All of them will lose if the ACA is repealed and not replaced by a plan with comparable coverage and parity for treatment of opioid use disorders.
Previously: Drug dealer MD: a look at the opioid epidemic, Overprescribing of opioids is not just limited to a few bad apples, The problem of prescription opioids: “An extraordinarily timely topic” and Stanford addiction expert: “It’s often a subtle journey” from prescription-drug use to abuse
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