How The American Health Care Act May Worsen The Opioid Crisis

By Paul Gaita 05/08/17

One provision in the bill would grant states the rights to eliminate services for mental health and drug addiction from Medicaid plans.

People protesting the American Health Care Act  in North Carolina

As Republicans celebrated the passage of the American Health Care Act (AHCA) in the House on May 4, the bill has faced a growing chorus of criticism and outright opposition from news outlets, medical organizations and even conservative think tanks. Chief among the issues taken with the AHCA is its drastic reduction of Medicare funding by capping federal payments to its programs.

Funding to Medicare would be cut by an estimated 25%, or $880 billion over the next decade, while an additional provision would grant states the rights to eliminate services for mental health and drug addiction from their respective Medicaid plans. The capping may force states to either draw from their own budgets to continue funding Medicaid, or discontinue services to low-income individuals, nursing homes and opioid drug users—a scenario described by Baltimore health commissioner Leana Wen as "medically [and] fiscally irresponsible," and potentially responsible for "[costing] the lives of thousands of people."

Dr. Yngvild Olsen is among the many medical professionals who face the possibility of deciding which addiction patients can receive coverage. A member of the Coalition to Stop Opioid Overdose and a board member at the American Society of Addiction Medicine, Dr. Olsen outlined the dilemma facing addiction services patients should the AHCA become law: "If they are now unable to access care because of the changes to the Medicaid infrastructure and the financing structure, as well as increased premiums on the individual market, then they may need to make tough decisions about if they're going to continue the care, and whether we are going to continue providing care for them. For people who have achieved recovery and stability, that is something that they value extremely and are rightfully concerned. It's something they're not going to be able to continue."

Those excluded from coverage face steep financial obstacles, should they wish to continue their treatment by paying out-of-pocket. "Outpatient opioid addiction that includes medication like methadone averages between $6,000 and $8,000 a year," said Dr. Olsen. "If you are providing buprenorphine, the price goes up" to approximately $400 to $500 a month, while injectable Vivitrol will cost $1,000 per injection.

Access to the life-saving opioid overdose reversal drug naloxone will also prove costly, since states will be allowed to determine their respective degrees of coverage, and addiction would be considered a pre-existing condition; placing the individual in a "high-risk pool," which was granted $8 billion under an amendment to the bill, offers no guarantee that the pool will have the funds available when needed. "Depending on what the benefit looks like, depending on how expensive it is and what the copays are, it's very possible that the access to overdose reversal medication could also be affected," said Dr. Olsen.

The longterm impact of the AHCA upon opioid addiction in America would be an "unprecedented setback," according to Dr. Olsen, who likened the current state of addiction to the environment in major cities like Baltimore in the 1990s, when heroin overdoses surpassed homicide as the leading cause of death. With the addition of such powerful and lethal drugs as fentanyl to the black market, Dr. Olsen believes that the overdose death rate will only continue to rise.

Her advice to patients is to directly address state representatives to voice concerns and demand action. "This is about people and it's about Americans who have conditions for which the effective treatments and recovery can – and does- happen," said Dr. Olsen. "To now have to respond to people's anxieties and fear and worry that we won't be able to save lives any more, it's really disheartening." 

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.