By Orla Kennedy, Community Catalyst; Deborah Steinberg, Legal Action Center; and Lindsey Vuolo, Partnership to End Addiction

One in three people knows someone who has died from a drug overdose. Behind every statistic is a family grieving, a life cut short, and a system that failed to provide care. Despite years of progress in reducing stigma and expanding treatment, the federal government is now threatening to undo it all through a coordinated set of policies that threaten the lives of nearly 50 million people with substance use disorders (SUD) in the United States.

Dismantling federal resources dedicated to SUD 

Rather than expanding access to treatment as promised, the federal government is dismantling it. The Trump Administration has gutted the agency most responsible for behavioral health – the Substance Abuse and Mental Health Services Administration (SAMHSA) – by slashing staff, proposing to cut over a billion dollars from its programs, and burying it within a larger bureaucratic agency with no clear mandate to fight the overdose crisis or support people with SUD. Grants for treatment and prevention programs, research, and data are all at stake, if not already cut. National Institutes of Health funding and staff cuts and proposed restructuring also threaten SUD research and future advancements in prevention and treatment.   

Medicaid cuts will significantly harm people with SUD 

Amidst these attacks – and in order to cut taxes for billionaires – Congress is proposing cutting the Medicaid program, a lifeline for more than 70 million people. Medicaid is the single largest payer of behavioral health services, covering tens of millions of people with these conditions.

The majority of people with opioid use disorders in Medicaid are low-income, able-bodied adults without dependents who are covered through Medicaid expansion, the very population that is targeted in the budget reconciliation bill that has already passed the House. A key feature of the bill is work reporting requirements that force an individual to prove, through either burdensome reporting processes or error-ridden data matching, that they are working a certain number of hours per week in order to keep their health insurance. Requiring proof of employment to obtain health care is wrong, and it’s especially problematic for people with chronic illnesses like SUD, for whom losing health insurance might be fatal. Data from other benefits programs show that these requirements are consistently ineffective at promoting work and instead lead to coverage loss and medical debt. 

Communities of color are especially at risk: research shows that while overdose deaths among white people are declining, deaths among people of color are increasing. At least half of Medicaid enrollees identify themselves as Black, Latinx, or another person of color; cuts to this program have the potential to further hurt communities already struggling to access quality care. Already, the vast majority of people who need SUD treatment do not receive it, frequently citing concerns about stigma, time, cost, and not knowing where or how to get treatment. Congress’s proposals will make getting care even harder, which in turn will cost more money – and more lives.  

Removing and declining to enforce protections in commercial health plans

Congress’s message is clear: only working people deserve health care. And yet, as millions of people lose access to Medicaid and SAMHSA-supported resources, commercial insurance for employed people is also under attack. The Congressional budget reconciliation proposal also includes numerous provisions that would make it harder for people to enroll in affordable commercial health insurance. Moreover, individuals who do not meet the proposed Medicaid work reporting requirements would be barred from receiving subsidized health care through the marketplace. 

But there’s more: the Administration is also pausing enforcement of (and may even revoke) regulations strengthening the Parity Act – the law that requires mental health and SUD care to be treated the same as physical care. The Parity Act protects individuals with these conditions from discrimination in their health insurance coverage. Without enforcement, insurers consistently violate this law, forcing people with SUD and their families to pay for their treatment out of pocket or forgo the care they need. 

The main reason for not enforcing parity laws? According to the federal government, it’s too burdensome and costly for insurance companies. Yet the Administration seems to have no problem shifting the burden and costs onto individuals with SUD and families struggling to get the treatment they need, as they’ll now have to fight discriminatory insurance denials through complicated and time-consuming appeals processes. And Congress is simultaneously proposing similar burdens and costs for individuals with SUD in Medicaid. These actions, especially taken together, fly in the face of what voters really want: polling shows that voters across the political spectrum want the government to do more to ensure affordable, accessible care for the people.

Prioritizing tax breaks over people with SUD and their families 

The Administration acknowledges the ongoing overdose crisis is still a public health emergency. Yet, the federal government is signaling that it is willing to compromise hard-fought yet insufficient progress on declining overdose rates, trading lives for tax cuts that only benefit the rich and corporations. Communities across the country will pay the price. We cannot accept cuts or other actions that will deepen this crisis that claimed 220 lives each day in 2024. Tell Congress, tell the Administration: No Cuts to Medicaid; protect parity; and put people, not profits, first. The lives of our friends, our families, and our communities are at stake.

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About the Authors:

Orla Kennedy, MSPH, is a senior policy analyst for the Substance Use Disorders Program at Community Catalyst, a health advocacy organization working to build the power of people to create a health system rooted in race equity and health justice, and a society where health is a right for all. 

Deborah Steinberg is a senior health policy attorney at the Legal Action Center where she advocates for state and federal policies to improve access to substance use disorder and mental health care. 

Lindsey Vuolo, JD, MPH, is the vice president of health law and policy at Partnership to End Addiction, where she performs legal, regulatory, and policy work related to addiction prevention and treatment.