Repealing ACA Could Undermine Response to Opioid Epidemic in Rust Belt States
America’s rust belt has been struggling with an opioid epidemic for the last two decades that has taken the lives of thousands of people and brought national attention to the indiscriminate way it has harmed so many families. In states such as Kentucky, Ohio and West Virginia, three of the five states with the highest rates of death due to drug overdose, it is easy to see the real consequences ahead if repeal of the Affordable Care Act (ACA) occurs. The expansion of coverage through the ACA and its provision of life-saving services have been essential strategies for combating this epidemic.
A number of recent reports capture the benefits of substance use coverage provided through the ACA nationally and in these states, and what repeal would mean for those with opioid addictions. Overall, repeal could eliminate coverage for up to 2.8 million Americans with a substance use disorder, including about 222,000 with an opioid disorder.
According to a recent report from The Foundation For A Healthy Kentucky, prior to the implementation of the ACA approximately 585,000. Kentuckians lacked coverage for substance use treatment mainly because they did not have access to any form of health insurance. The combination of Medicaid expansion, private insurance tax credits and requirements for coverage of substance use disorders treatment, all included in the ACA, enabled 320,000 uninsured people to get covered and another 300,000 who were already insured to get access to better coverage of substance use treatments. This gave the people of Kentucky a real fighting chance to combat the opioid epidemic.
Similarly, in neighboring Ohio, the misuse of powerful opioids, such as heroin, fentanyl and prescription painkillers, continue to drive up the state’s overdose deaths. The ACA has helped people get treatment. Thirty thousand Ohioans with substance use disorders are currently covered through the Marketplace according to a recent report from experts at Harvard University and New York University. In addition, Medicaid expansion greatly expanded access to substance use treatment. An additional report from the Department of Health and Human Services found that 75 percent of expansion enrollees who sought care for problematic use of drugs and alcohol reported improved access to care, and 83 percent reported improved access to prescription medications. ACA repeal would cut in half the state’s funds for evidence-based Medication Assisted Treatment (MAT), the most effective treatment for opioid addiction, and care that can make all the difference for Ohioans battling opioid addiction.
In Kentucky, Medicaid pays for between 35-50 percent of all MAT. Since Kentuckians gained access to treatment through the Medicaid expansion in 2014, use of alcohol and drug treatment services grew by more than 700 percent. Research shows that many of the new enrollees had been previously uninsured and therefore had limited, if any, access to treatment until 2014. Substance use treatment services also increased for adults enrolled in traditional Medicaid, increasing by more than 300 percent in the same time period. Individuals whose options for treatment had been limited prior to the ACA were not only enrolling in health coverage, they were also using life-saving treatment options.
States with the highest overdose rates in the nation, such as West Virginia and Kentucky, which in 2015 ranked first and third in overdose death rates, will see their uninsured rates nearly triple if the ACA is repealed. This points to the real life consequences losing coverage will have in communities trying to get ahead of this epidemic. Two weeks ago, one city in West Virginia had 26 overdoses in the span of four hours, reminding us that what we need now more than ever is access to coverage, harm reduction servicesand treatment.
Though we are still in the midst of the opioid epidemic, these recent studies confirm that the ACA made considerable headway in treating opioid disorders. If Congress repeals the law, it is hard to imagine that the coverage and treatment gains will be sustained. Instead of repealing the ACA and constructing additional hurdles for people to jump over, Congress should focus on what has proven to work. They should build on that success and protect our care.