By Alison Knopf
President Trump promised to repeal the Affordable Care Act (ACA), and although it took some negotiating, he got what he wanted from the House of Representatives on May 3. That’s when the House passed the American Health Care Act (AHCA), repealing key provisions of the ACA.
Many organizations in the treatment field, including the American Association for the Treatment of Opioid Dependence (AATOD), Acadia Healthcare, and 433 others, sent a letter immediately to House Speaker Paul Ryan and Senate Leader Nancy Pelosi objecting to the AHCA.
“We are very concerned that the AHCA’s proposed changes to our health care system will result in reductions in health care coverage, particularly for vulnerable populations including those suffering from substance use disorders and mental illness,” they wrote.
The letter noted that more than 20 million Americans have obtained coverage through the ACA. Many of these individuals couldn’t access treatment for substance use disorders until the ACA expanded Medicaid to low-income adults (in many states, only pregnant women and children had been eligible).
The letter cited the opioid overdose epidemic and the need for insurance reimbursement for medications to treat substance use disorders. The letter also noted that the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provides parity of coverage for substance use disorders and mental illness, on the same level as other medications. It was the ACA that extended MHPAEA to the small and individual-group market, as well as to Medicaid expansion plans.
“Turning the Clock Back”
As authors writing in The New England Journal of Medicine recently noted, “Repeal of the ACA would dismantle these protections and turn the clock back to a time when most Americans were subject to restrictive and inequitable limits on coverage for medication treatment and other supplementary treatments for opioid use disorder.”
That letter concluded, “we implore you to keep in mind how your decisions will affect the millions of Americans suffering from substance use disorders and mental illness who may lose their health care coverage entirely or see reductions in benefits that impede access to needed treatment.”
“We Are Very Concerned”—435 Signatories
Among the signatories:
- Acadia Healthcare
- Addiction Policy Forum
- American Correctional Association
- American Academy of Addiction Psychiatry
- American Association for the Treatment of Opioid Dependence
- American Congress of Obstetricians and Gynecologists
- American Public Health Association
- American Psychiatric Association
- American Psychological Association
- American Society of Addiction Medicine
- Clean Slate Addiction Treatment and Rehabilitation Centers
- Faces and Voices of Recovery
- Facing Addiction
- Hope House Addiction Services
- Legal Action Center
- NAADAC – the Association for Addiction Professionals
- National Alliance for Medication-Assisted Recovery (NAMA)
- National Association of Addiction Treatment Providers
- National Association of Drug Court Professionals
For the full letter with the complete list of signatories, go to https://www.naadac.org/assets/2416/cwh-ahca-opposition-letter-05032017.pdf.
Insurance in Name Only?
A letter the American Society of Addiction Medicine (ASAM) sent to Congress on March 9 noted that repealing the ACA would be particularly painful for people who need addiction treatment, especially during the opioid epidemic. The result could be “insurers offering addiction treatment benefits in name only due to higher costs and/or less robust benefits.”
The letter also noted that Medicaid expansion had reduced the population of uninsured people hospitalized with addiction or mental illness from 20% in 2013 to 5% in 2015—illustrating why hospitals are so concerned about ACA repeal.
Undermining the Cures Act
The Cures Act, which President Obama signed in December 2016, thereby funding opioid addiction treatment by an additional $1 billion for two years, would be largely undone by the ACA. Before President Trump’s inauguration in early January, Richard G. Frank, PhD, wrote that repealing the ACA would erase the gains of the Cures Act.
Along with co-author Sherry Glied, PhD, Dr. Frank, formerly assistant secretary for planning and evaluation in the Department of Health and Human Services, noted that Cures was necessary to close an opioid treatment gap in which 420,000 people said lack of finances or service availability prevented them from getting treatment. Repealing the ACA would “increase that gap by over 50% with the stroke of a pen,” the coauthors wrote in The Hill on January 11.
‘Stemming the Tragic Toll’
“The Congress and the American people have come to realize that stemming the tragic toll of opioid misuse and addiction and serious mental illnesses takes funding as well as policy,” they wrote. “It would be a cruel sham for Congress to take an important, but modest, step forward in investing in treatment capacity, while withdrawing funds from the enormous recent progress made in addressing the needs for care of those with mental health and addictive illnesses.”
People with the greatest need for treatment would end up in prison or jail, instead, said Dr. Frank. “Without the foundation of that ongoing financial support, those in the eye of the opioid storm and those who live in society’s shadows due to serious mental illnesses will continue to die of untreated illness, and their communities will continue to pay for the jails, prisons and homeless shelters that serve as our de-facto service system for many with these conditions.”
Dr. Frank estimated that about 222,000 people with an opioid use disorder would lose some or all their insurance coverage under ACA repeal.
Virtually every single health care organization opposed the AHCA.
On May 24, the Congressional Budget Office (CBO) came out with its score on the AHCA (the House voted to pass it before the usual CBO rating because it was in a rush). The CBO found that the AHCA, especially the Medicaid reductions of $880 billion, would be disastrous for health care, and would lead to 23 million Americans’ losing coverage in a decade. For the CBO analysis, go to https://apps.npr.org/documents/document.html?id=3731724-CBO-Report-On-AHCA-As-Passed-By-The-House.
Debate on health care reform now moves to the Senate.