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

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.
As the Senate considers its version of a bill to repeal the Affordable Care Act (ACA) and gut Medicaid funding, talks have focused on providing a separate, limited amount of funding to combat the opioid epidemic. This funding – which would exist outside of Medicaid – would include payment for substance use disorder (SUD) treatment as an alternative to providing Medicaid coverage that many individuals gained through the Medicaid expansion (which AHCA would repeal).
Establishing separate funding does not offer a workable solution for the states hardest hit by the epidemic including Maine, Ohio, and West Virginia. The amount of money being considered would fall significantly short of the actual need. Further, compartmentalizing SUD services fails to recognize the need for ensuring access both to SUD services as well as other health services as part of treatment. The best “treatment” is to maintain the Medicaid expansion eligibility for all those who have gained it and to maintain the ACA protections that ensure comprehensive prevention and treatment for substance and opioid use disorders (OUD).
The opioid epidemic continues unabated. In 2015, over 33,000 Americans – more than 90 a day – died due to an unintentional opioid-related overdose, more than any year on record. Preliminary data from 2016 show that the number of Americans lost to overdose increased by nearly 20 percent from 2015 to 2016, due largely to the continuing opioid overdose epidemic.
State Specific Fact Sheets
Please click on the links below for updated state specific resources to help educate lawmakers about the impact of BCRA on the opioid epidemic. Resources concerning the impact of per capita caps can be found at the bottom of the page
Alaska Arizona  Maine
Nevada Ohio Pennsylvania
West Virginia National Fact Sheet  

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.

Call your senators and urge them to vote against AHCA. For more information on AHCA and its impact on the Medicaid program, sign up for our email updates and follow us on Twitter and Facebook.

State Specific Fact Sheets Related to Per Capita Caps
Please click on the links below for state specific resources to help educate lawmakers about the impact of per capita caps on the opioid epidemic
Alaska Arizona  Maine
Nevada Ohio Pennsylvania
West Virginia Alabama National Fact Sheet 

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