In our opinion: ACA repeal could stymie efforts to end the opioid epidemic

Uninsured hospitalizations for addiction fell in West Virginia after Medicaid expansion 

Expanding access to treatment for individuals struggling with addiction is a central theme in A Prescription for Action, the joint report recently published by NACo and the National League of Cities. 

The report points out that although nearly the same number of individuals in the country suffer from diabetes (29 million) and addiction (21 million), roughly 75 percent of individuals suffering from diabetes receive treatment, but only about 12 percent of those struggling with addiction are being treated.

And that amount might drop.

Federal policy changes underway in the first weeks of the 115th Congress point to potentially significant decreases in the availability of addiction treatments.

In both the House and Senate, lawmakers approved resolutions during the second week of January that set the stage for a repeal of the Affordable Care Act (ACA).

If these repeal efforts prove successful — as is expected — individuals throughout the country who rely on ACA exchanges for health coverage could lose access to addiction treatments.

Additionally, in the 31 states that have expanded Medicaid under ACA guidelines, individuals newly-eligible for Medicaid could once again find themselves unable to secure health coverage.

A recent study published by the Harvard Medical School and New York University helps to quantify the potential impact of repealing the ACA on efforts to stem the tide of the opioid epidemic.

According to the study, several states that have been particularly hard-hit by opioids have relied on the ACA and Medicaid expansion to fund addiction treatments.

In Ohio, for example, which experienced more than 3,000 drug overdose deaths in 2015 according to the Centers for Disease Control (CDC), nearly 30,000 individuals struggling with addiction accessed health coverage through ACA exchanges. Additionally, more than 150,000 individuals with mental illness and substance use disorder conditions gained access to Medicaid coverage through Ohio’s expansion under ACA.

Ohio Gov. John Kasich (R) recently credited Medicaid expansion in helping his state fight the opioid epidemic, stating that “Medicaid money is helping to rehab people.”

In nearby Kentucky, the story is similar. In 2015, 67 of the state’s 120 counties had more than 20 overdose deaths per 100,000 residents, according to the Foundation for a Healthy Kentucky (FHK).

In a recently released study, the foundation found that treatment services for substance use increased by 740 percent for Medicaid expansion beneficiaries between the beginning of 2014 and mid-2016 — from about 1,500 individuals to about 11,000. While the report points out that rising rates of opioid abuse in Kentucky have likely also contributed to this dramatic rise in treatments, the positive impact of Medicaid expansion seems unmistakable.

As Congress moves towards a repeal of the ACA and defunding of Medicaid expansion, the nation’s efforts to curb rates of opioid abuse and overdose — especially in several particularly hard-hit states — could lose momentum. If lawmakers are able to implement a replacement program that facilitates similar rates of access to health coverage for the general population and the Medicaid “expansion population,” without significant disruptions to coverage, the adverse impacts of an ACA repeal on individuals struggling with opioid addiction could be largely mitigated. Without an effective replacement, these adverse impacts seem hard to overstate.

In West Virginia — which is perhaps the epicenter of the opioid epidemic — it is estimated that the share of hospitalizations for addiction or mental health disorders in which the patient was uninsured decreased from 23 percent to 5 percent as a result of Medicaid expansion.

Recently, Sen. Joe Manchin (D-W. Va.)  stated that “half of the people in treatment would lose coverage made possible through the Affordable Care Act,” and that “West Virginians cannot afford to have this critical funding ripped from them without a replacement ready.”