While many health care providers see Medicaid and Medicaid expansion as the most powerful tools for helping Ohioans access addiction treatment, both programs are on the chopping block under the House and Senate versions of the American Healthcare Act (AHCA).
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Medicaid expansion made addiction treatment much more widely available (especially to single men) in Ohio, by basing Medicaid eligibility on income rather than disability. Under expansion, 500,000 Ohioans have gotten access to substance abuse treatment and mental health services.
Andy Albrecht, CEO of Counseling Center (a southern Ohio substance abuse treatment program) calls Medicaid expansion the single biggest thing to ever happen to his agency. Under expansion, Counseling Center has been able to offer addiction treatment to 1,100 men who would not have been previously eligible for Medicaid, and has worked with county jails to divert 400 of these men from jail to rehabilitative services. The agency has been able to hire 67 full-time staff members with expansion funding, greatly increasing its capacity to reach clients.
Medicaid as a whole pays for an astonishing amount of front-line addiction services in Ohio. Fully $650 million of the $1 billion Ohio spent on efforts to reduce overdose fatalities in 2016 came through Medicaid funding for addiction and behavioral health services. Last year alone, Ohio Medicaid paid for over 30,500 doses of Vivitrol (an injection that blocks brain receptors when on opioids).
If bringing care to the many Ohioans fighting addiction is a priority, it seems odd that Congress would paralyze Medicaid and Medicaid expansion, the two programs that have been fighting this crisis head-on. But that’s exactly what both the House and Senate health care bills would do.
Both bills would effectively end Medicaid expansion and make steep funding cuts to Medicaid ($772 billion by 2026 under the Senate version.)
Both bills would cap federal Medicaid funding per enrollee according to set growth rates. While that’s complex to understand, the upshot is that under per capita caps, in the event of a public health crisis like Ohio’s opioid epidemic, it would be entirely up to the states to come up with additional money to meet these emergency costs. Additional federal money would no longer be triggered by need, as it has been until now.
But it’s not just through cuts to Medicaid that the House and Senate bills would harm addiction treatment. Substance abuse treatment is one of the 10 Essential Benefits (like maternity care, prescription drugs and hospitalization) that insurers have been mandated to cover under Obamacare. Both the House and Senate bills would let states to decide if insurers must cover these basic services, leaving many insured Americans without addiction treatment coverage.
This public health crisis, and the cost of treating it, are growing at incomprehensible rates. Richard Frank of Harvard Medical School projects that it if the AHCA’s coverage losses go into effect, it will cost $183 billion over 10 years to meet the nation’s growing costs of opioid treatment.
The Center for American Progress projected that if treatment needs continue to grow as they have, Ohio will need $2.2 billion for opioid treatment in 2026 alone. The $45 billion opioid treatment fund reportedly being considered by the Senate would provide Ohio just $272 million that year.
The many Ohioans in desperate need of assistance to overcome addiction deserve more, and need more, than rhetorical solutions. They need help, help that Medicaid and Medicaid expansion are already effectively providing.
Wendy Patton is Senior Project Director for Policy Matters Ohio, based in Columbus.