My People Are Dying: Rollback of US Medicaid Expansion Could Mean the End of Life-Saving Treatment for Far Too Many
It has been only three weeks since Speaker Paul Ryan unveiled the American Health Care Act, legislation that repeals portions of the Affordable Care Act (ACA). This legislation, in its current form, would rollback provisions in the ACA that have provided coverage for millions of people who struggle with substance use or mental health disorders through Medicaid.
Medicaid is a federal insurance program that provides health coverage for low income, elderly, and disabled people. The ACA expanded Medicaid funding for states and eligibility requirements allowing millions of new people to access drug and alcohol treatment they could not afford out of pocket. 32 states and D.C. subsequently agreed to expand Medicaid coverage for low-income residents.
The American Health Care Act pending in Congress this week, however, would suspend this Medicaid expansion by 2020. The bill would also eliminate a federal mandate that states that expanded Medicaid cover mental health and substance use treatment coverage.
Because most states won't bear the cost without federal help, these eliminations of coverage mean a likely end to medication-assisted treatment (MAT) for people who are currently covered. So far, it's been clear that medications like buprenorphine and methadone are critical to stepping down the opioid crisis, even incrementally. Without means to pay for MAT or other treatment access out-of-pocket, or adequate coverage under the proposed health care plan, people who currently rely on Medicaid could be forced into a Catch-22: try and fail to find access to affordable treatment options, or relapse into what could become problematic substance use.
Full stop, the implications of passage of the American Health Care Act in its current form would be a stripping away of coverage and access to care for the most marginalized. As we endure a nationwide opioid crisis, this likely means the difference between life and death for many.
As a person in long-term secular recovery from problematic substance use, I know first-hand the life-saving value of access to clinical, science-based treatment. These programs are often medically assisted, which is especially necessary in the case of many opioid users.
In virtually all cases, one must have insurance coverage to even think about having access to treatment.
Medicaid expansion did not magically cure problematic substance use, nor can health insurance coverage alone solve the opioid epidemic — but it has made a dent. People who previously had no means to seek treatment — nearly three million of them — now have coverage. Many of these individuals who now have coverage are opioid users, in many cases residing in states with surging opioid deaths like Ohio, Kentucky, and West Virginia.
As a former substance user, I can tell you — sustained, adequate treatment is the key to saving lives. Those disenfranchised by the passage of the American Health Care Act will continue struggling, and could relapse into more dangerous and fatal drug seeking and use behaviors. In some cases, it's virtually guaranteed.
Additionally, turning our backs on this public health crisis directly increases the likelihood of substance users developing expensive and potentially deadly medical conditions, or contracting and transmitting blood borne disease. If you can't get your methadone and mental health care, it's all too easy to slip back into sharing syringes and practicing dangerously unsafe substance use.
The Drug Policy Alliance advocates for increased federal and state funding for drug treatment and believes that treatment should be available to anyone who wants it. The American Health Care Act would take drug treatment away from millions of people, and worsen the opioid crisis.
Any replacement health care bill in Congress must include the continued expansion of Medicaid, including Medicaid coverage of mental health and substance use treatment. The bill must also mandate the continued requirement that all insurance providers include coverage for substance abuse treatment at parity with medical and surgical services.
These are my people, and my people are dying at alarming rates from problematic substance use and overdose. If passed, the American Health Care Act would eliminate drug treatment coverage by suspending Medicaid expansion and rolling back federal assistance to states, leaving millions vulnerable to the opioid crisis. Congress and President Trump must understand that a suspension in coverage and access yields the end of services and treatment for millions. For many, this could be a death sentence.