Congressional Effort to Repeal ACA & Cut Medicaid Would Worsen the Opioid Epidemic

*This post has been updated with new state specific fact sheets to reflect the Senate’s latest version of its so-called “Better Care Reconciliation Act of 2017” or BCRA.

ACA is a vital tool in the fight against the opioid epidemic. Thanks to ACA’s Medicaid expansion, 1.2 million individuals with SUD now have access to health insurance. Similarly, ACA’s marketplace exchanges have significantly improved access to insurance in the states hardest hit by the epidemic. Almost 70,000 Ohioans and 100,000 Pennsylvanians with serious mental illness have gained coverage through the individual marketplace.

ACA also ensured that individuals with SUD have access to evidence-based prevention and treatment services. As part of a package of essential health benefits (EHBs), Medicaid and private health plans must now cover mental health and SUD services as well as medication-assisted treatment (MAT) and the overdose-reversal medication naloxone. ACA, moreover, expanded the mental health parity requirement, under which most private health plans are prohibited from imposing limitations on coverage for substance use services that are greater than limitations on coverage of medical and surgical services.

Current efforts in Congress to pass AHCA are aimed at repealing most of ACA’s protections for people with OUD and slashing Medicaid funding for SUD services by eliminating the enhanced funding for the expansion and by imposing per capita caps on federal Medicaid funding. And 2.8 million Americans with SUD, including 222,000 with OUD, stand to lose some or all of their health insurance if AHCA is enacted, increasing the risk of overdoses and other negative consequences associated with this public health emergency.

BCRA will result in:

Fewer individuals with OUD enrolled in Medicaid
Eliminating enhanced federal funding for the Medicaid expansion and capping the amount states receive in federal funding will likely lead states to reduce Medicaid eligibility and restrict coverage for low-income adults with OUD.

Reduced OUD services coverage
By allowing states to waive the EHB requirements, AHCA would likely lead health plans to scale back or eliminate coverage of OUD prevention and treatment services.

Gutting of mental health parity requirements
The elimination of EHBs and the imposition of per capita caps on Medicaid funding will likely lead health plans to impose limitations on other services, which would permit them to impose limitations on coverage of OUD services as well.

Reduced services for pregnant women with OUD
The elimination of EHBs, particularly if coupled with an ineffective parity requirement, would lead health plans to reduce coverage for MAT with methadone and buprenorphine, the standard of care for pregnant women with OUD, and will increase the rate of neonatal abstinence syndrome (NAS).

Reduced ability to introduce innovative approaches to address the opioid epidemic
States’ ability to expand access to OUD treatment through Section 1115 demonstrations would be limited if Medicaid funding is reduced as a result of per capita caps.

Higher uncompensated mental health and OUD care
Cuts to federal Medicaid funding will shift the cost of treating low-income individuals with OUD to safety-net providers and local hospitals, likely leading to higher costs for everyone. State budgets would bear the brunt of these increases without the federal funding support currently provided by Medicaid.

Higher costs to the U.S. economy
By increasing the number of people with OUD who cannot access timely, effective treatment, AHCA will contribute to higher criminal justice costs and loss of productivity, which will continue to disproportionately affect states hardest hit by the opioid epidemic.

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