The one near-certainty in GOP efforts to patch up their failed Obamacare repeal bill over the July Fourth break is that they will add more money to combat the opioid crisis — at least $45 billion, by all accounts.
That may entice some moderate lawmakers to support the bill. But it will do little to fulfill Donald Trump’s campaign promise to address the crisis devastating so many communities. And it certainly won’t make up for the Medicaid cuts that many members of his own opioid commission oppose because tens of thousands of people who are addicted to the drugs would lose regular health coverage.
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Addiction experts and others across the political spectrum say that boosting the current bill’s $2 billion for substance abuse services is like applying a Band-Aid to a gunshot wound. Throwing a one-time pile of cash at addiction won’t make it go away, say critics. It’s a complex, lifelong, medical problem that requires regular health care.
“That’s like spitting in the ocean,” Ohio Republican Gov. John Kasich said of spending money on opioids without giving people ongoing health care.
The debate is particularly vexing for GOP leaders since many of the states hardest hit by opioids, including West Virginia, Ohio and Maine, went for Trump and are also home to a group of moderate senators still on the fence about the repeal bill.
West Virginia Republican Sen. Shelley Moore Capito for instance, who has sought an infusion of $45 billion in opioid funding in the bill along with Ohio Sen. Rob Portman, said Wednesday that that money would have to be paired with more generous Medicaid provisions to get her support.
“To me, it goes hand-in hand,” Capito said on CNN Wednesday morning. “You won’t access the [substance abuse] treatment without the [health insurance] coverage, whether from the exchanges or Medicaid.”
Sen. Maggie Hassan (D-N.H.), whose state has had a devastating problem with opioid addiction, said that it’s absurd to think that a “siloed small amount of money” for opioid treatment can work without an integrated health system.
People struggling with addiction need regular access to the health system so they can be treated for the conditions that often lead to, or develop due to their substance abuse — among them, chronic pain, untreated broken bones, traumatic brain injury, dental problems, diabetes, breathing conditions, and heart and liver disease, said Lori Criss, associate director of the Ohio Council of Behavioral Health and Family Services Providers.
State-specific opioid grants won’t cover those things and without such care, abusers are unlikely to remain stable and employable, Criss said.
The Senate bill yanked this week by leaders would make $772 billion in cuts to Medicaid over 10 years, including the rollback of the federal government’s funding of Obamacare’s expanded Medicaid eligibility — through which an estimated 1.3 million people have gotten mental health care and substance abuse coverage.
The bill would also repeal an Obamacare requirement that Medicaid expansion must cover mental health and substance abuse. It also allows states to apply for waivers so they do not have to require coverage of substance abuse treatment.
Harvard health economist Richard Frank, an HHS official under former President Barack Obama, estimates that approximately 2.8 million Americans with substance use problems — of whom about 222,000 have an opioid disorder — would lose some or all of their insurance coverage if Republicans repeal Obamacare and its behavioral health provisions.
Both Republican and Democratic members of the president’s opioid commission, including panel chairman New Jersey Gov. Chris Christie, acknowledge that Obamacare’s expanded Medicaid has been a boon to getting drug abusers into treatment.
“When I expanded Medicaid eligibility in New Jersey by Executive Order in 2013, it created a sea change in the availability of drug treatment for the poor in New Jersey,” Christie said in his January 2017 State of the State address. “In 2016, 14,357 Medicaid recipients are receiving drug addiction treatment. This represents a five-fold increase over 2013.”
Former Rep. Patrick Kennedy, a Democrat on the opioid panel, says he has no doubt the bill would undercut efforts to stem the opioid crisis.
“We can’t bury our heads in the sand with some kind of budget deal or health care reform and think that somehow everything is going to be OK,” Kennedy said.
Republican John Giles, the mayor of conservative Mesa, Ariz., said Wednesday that the repeal bill might save money for the federal government but it would almost certainly boost costs to state and local governments.
“Any savings will be more than eaten up by the increased public safety budgets [for cities] like Mesa, Arizona,” he said. “Emergency medicine is not the correct way to respond to the crisis we are facing. It’s less effective. We need more preventative care.”
Frank estimates that states would need about $183 billion over 10 years to successfully tackle the opioid crisis — about four times the amount that Portman and Capito have sought.
“Not only is it disingenuous to say that a slush fund will be appropriate to care for people but it’s really comprehensive and integrated coverage that is what people with addiction need,” said Michael Botticelli, head of the White House’s Office of National Drug Control policy under Obama.
The type of treatment that could be financed through state grants would also be far different than what patients get now, many experts said.
Most of the patients receiving access to drugs that help treat addiction currently get them through private doctors’ offices — where they are more likely to receive treatment for underlying diseases like depression, or for diseases like HIV that sometimes occur as a result of their addiction.
“That would be almost impossible to do through grants,” Frank said.
That’s because federal grants for behavioral treatment typically go to specific public providers or clinics that address addiction, many of which lack the capacity to treat all those in need or to offer broad health services.
Many of those do not follow the evidence-based medical practices that addiction professionals recommend, Kennedy said.
For example, a lot of money goes to facilities offering “12-step programs,” best known for treating alcoholics, which don’t offer medication to treat opioid addiction or cognitive behavioral therapy, he said. And they don’t treat patients associated ailments like depression and bipolar disorder.
The reason the country’s relapse rate is so high is “because the current system doesn’t work,” Kennedy said.
Finally, many health policy experts say the country can’t count on the opioid epidemic being over when the Senate’s grant money runs out.
“We will be struggling with this problem for the rest of our lives,” said Andrew Kolodny, co-director of opioid policy research at Brandeis University.
Jennifer Haberkorn and Brianna Ehley contributed to this story.
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