America’s addiction crisis is the defining public health challenge of our time. In 2015, more than 52,000 Americans died of drug overdoses, the majority related to opioids — far more than died from car accidents. More than 20 million Americans live with substance use disorders, leading to immeasurable suffering for individuals and families and costing our nation a staggering $442 billion in health care costs, lost productivity, and criminal justice expenses.
Tragically, the American Health Care Act (AHCA) passed by the House would be a major step backward in addressing the addiction epidemic in America. The Senate reportedly is following the same harmful path, and aims to vote on its bill next week.
Wherever I traveled as surgeon general, from Rust Belt cities to remote Alaskan fishing villages, I saw the toll of addiction on individual and families who struggled with treatment shortages and the loss of loved ones to opioid overdoses. These stories compelled me to launch the Turn the Tide Rx initiative to improve opioid prescribing and to issue the first Surgeon General’s Report on Alcohol, Drugs, and Health in 2016.
Crystal Oertle was one person whose story stuck with me. She wrestled with opioid addiction for more than a decade. She started taking Vicodin at age 20, and eventually progressed to heroin. She knew she was putting herself and her two children in danger. Yet each time she tried to stop, the crippling symptoms of withdrawal pulled her back.
Fortunately, Crystal found a treatment program in her small Ohio town in 2015. It offered regular meetings with a doctor, group counseling and a reliable prescription for buprenorphine — an evidence-based scientific approach known as Medication-Assisted Treatment. With time, treatment and hard work, Crystal rebuilt her life and her relationships. Last spring, she shared her story before a national audience, offering living proof that recovery is possible.
A successful recovery like Crystal’s almost always requires health insurance coverage that includes treatment for substance use disorders. Key elements of the 2010 Affordable Care Act (ACA) provided such coverage to millions of people living with substance use disorders — but the AHCA could take it away.
The ACA dramatically increased health insurance coverage by expanding Medicaid to people slightly above the poverty line and providing need-based subsidies for private market coverage. It’s worth noting that Medicaid expansion is a quietly successful bipartisan policy. Thirty-one states with Democratic and Republican governors participate. Senators from both parties have publicly acknowledged its importance in improving access to addiction treatment. And a large majority of Americans support continuing current federal funding for Medicaid expansion. However, the House bill would end the Medicaid expansion; cap and cut federal Medicaid funding for seniors, people with disabilities and families with children; and cut subsidies for private insurance. The result would be 23 million more Americans without health insurance.
But there is another important implication of AHCA for people with substance use disorders. Prior to the ACA, only a third of individual market plans covered treatment for such disorders. People would often find out too late that their plans did not pay for the care they needed. The ACA changed this by requiring that all insurance plans cover addiction treatment as an essential health benefit. Unfortunately, the AHCA would once again allow insurance companies to opt out of providing this treatment. This means that even if people with substance use disorders have insurance coverage, they could face thousands of dollars in out-of-pocket costs for treatment, putting it out of reach for many.
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Senators say that they are fixing these problems, but from what we know so far, the fixes are nowhere near adequate. Medicaid expansion funding will likely still end — just more slowly than in the House bill. Millions of people will still be left without insurance. Senators may earmark some funding specifically for addiction treatment but, realistically, it won’t be enough to cover the vast numbers who would lose access to treatment. Even more important, such an approach ignores a fundamental reality that addiction is rarely an isolated condition. Many people living with substance use disorders need comprehensive insurance to treat related health conditions like chronic pain, anxiety and depression.
Ultimately, the AHCA would place coverage out of reach and weaken patient protections for millions struggling with addiction. This means more lives lost, more communities torn apart, and more people like Crystal and her children left behind.
In a rare moment of unity, our nation’s leading medical, nursing, hospital, disability and patient organizations stood together to express their grave concern that the American Health Care Act will in fact be disastrous for American health care and harmful to millions of patients. That’s because the people on the front lines of our nation’s health care system know that it would take us backward.
Martin Luther King, Jr. said, “the time is always right to do what is right.” It’s time to put people over politics and expand coverage and access to addiction treatment for millions of Americans who need it.
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