Why it's so hard to break an opioid addiction
Two Republican senators from states hard hit by the opioid epidemic want $45 billion for drug treatment programs folded into the Senate’s Obamacare replacement bill.
But health experts say their 10-year funding request won’t come close to providing the services needed by untold thousands of opioid abusers who are expected to lose their private health insurance and Medicaid coverage under the GOP legislation. That’s because opioid abusers typically have other health problems, like HIV, Hepatitis C, chronic pain or mental health problems that require additional treatment and services.
Funding only patients’ substance abuse treatment without addressing their other needs would likely prove ineffective, said Dr. Corey Waller, who chairs the legislative advocacy committee of the American Society of Addiction Medicine.
“You can’t treat any medical condition in isolation,” Waller said. “It just seems illogical at every level.”
The $45 billion proposal is being floated by Republican Sens. Shelley Moore Capito of West Virginia and Rob Portman of Ohio to make up for drug-treatment services that would be lost if the Senate repeal measure includes, as expected, massive cuts in Medicaid funding and in subsidies to purchase Obamacare marketplace insurance.
The $45 billion proposal is being floated by Republican Sens. Shelley Moore Capito of West Virginia and Rob Portman of Ohio to make up for drug-treatment services that would be lost.
Both Capito and Portman are key votes for Senate Majority Leader Mitch McConnell, who can afford to lose only two GOP senators as he pushes for a full Senate vote on the health bill. He delayed the vote earlier this week amid uncertain support within his caucus.
Neither Capito nor Portman would respond to reporters’ questions following a Senate Republican lunch last week.
The Senate legislation closely mirrors the House GOP bill, passed in May, which would slash $834 billion from the Medicaid program by changing its funding formula and phasing out the coverage expansion.
Considering the need for extra services and the fast growth of the opioid problem, Dr. Richard Frank, a Harvard University health economics professor, said roughly $190 billion over 10 years is closer to what’s actually needed.
Medicaid now covers about 34 percent of the estimated 2.66 million Americans with an opiate-use disorder, Frank estimates. That includes 99,000 people with opioid dependence who gained coverage through the Medicaid expansion.
Chuck Ingoglia, senior vice president for public policy at the National Council for Behavioral Health, agreed the $45 billion proposal isn’t enough.
“If we don’t deal with their co-occurring mental illness or chronic health condition, I don’t know that we’re going to be helping them,” Ingoglia said. “What are they supposed to do about these other things? How are they supposed to get care?”
Instead of a separate pot of money to deal with opioid addiction, Ingoglia said he’d like to see the Medicaid program continue in its current form to deal with the problem because it provides comprehensive care for people with substance issues.
It’s absolutely critical to my state, and we’ve got huge problems.
Sen. Shelley Moore Capito, R-W.Va.
But Medicaid is not sustainable to states and the federal government in its current form, said Jeff Myers, CEO of Medicaid Health Plans of America. Although reform is needed, Myers said the size and speed of Medicaid cuts proposed by congressional Republicans is problematic.
He said a separate pool to fund opioid treatment outside of Medicaid is “not optimal.”
“We believe that, given the size of the opioid challenge for Medicaid, this really ought to be included in the Medicaid funding stream,” Myers said.
About 120,000 people with an opioid problem also have marketplace insurance that requires coverage for substance abuse treatment, Frank said.
But that treatment option could disappear under GOP proposals that would leave millions without coverage and allow states eliminate or weaken Obamacare coverage of “essential health benefits.”
Repealing the Affordable Care Act without replacing its funding would cut $5.5 billion a year for drug and mental health treatment and cause 222,000 people with an opioid-use disorder to lose some or all of their Medicaid and individual insurance coverage, Frank reported in January.
They’re assuming that there’d be no cost increase with that $45 billion and the cost increases are huge.
Dr. Richard Frank, a Harvard University health economics professor, who says roughly $190 billion over 10 years is closer to what’s actually needed
In states like West Virginia, Ohio and Pennsylvania where the opioid epidemic is growing, the potential coverage losses under GOP repeal legislation would aggravate rising overdose and death rates.
That’s why Capito and Portman are calling for the $45 billion over 10 years. “It’s absolutely critical to my state, and we’ve got huge problems,” Capito told reporters recently.
But Frank said that level of funding – $4.5 billion a year over ten years – is based on the cost of providing only substance abuse services for one year for Medicaid expansion recipients. Treating all their conditions – as the Medicaid program currently does – would cost closer to $14 billion a year, Frank said.
Additionally, the $45 billion funding pool doesn’t account for the rapid growth of the opioid problem. Heroin addiction in the U.S. is growing at roughly 11 percent a year, while the mortality rate from opioid overdoses has grown about 9 percent a year over the last 20 years and grew 15 percent from 2014 to 2015, Frank said.
“They’re assuming that there’d be no cost increase with that $45 billion and the cost increases are huge,” Frank said. “We’re getting more people into treatment, which is a good thing. We have more people with the disease, which is a bad thing. And both of those are going to rack up costs.”
Republican health care negotiators want to draft legislation that can be voted on by the full Senate before their July 4 recess. But that is proving difficult as GOP conservatives clash with moderates like Capito, Portman, Susan Collins of Maine and Lisa Murkowski of Alaska who want to soften the effect of the legislation’s impact on older people, the poor and those with pre-existing medical conditions.
Republicans have 52 members in the Senate and could lose only two in order to pass the bill under budget reconcilation rules that block Democrats from filibustering tax and health care legislation. In the event of a 50-50 vote, Vice President Mike Pence would cast the tiebreaker.
Update: This story has been updated to reflect that the planned vote on the Senate bill was been delayed.