A new study by Harvard Medical School and New York University shows that repealing the Affordable Care Act would cut $5.5 billion a year for substance-abuse and mental health treatment, creating a 50 percent spike in the number of people unable to address their opioid dependence.
The lost funding would have sweeping implications as deaths from opioid abuse continue to rise across the nation and local governments struggle with the effects on their communities.
Repeal without replacement of funding would have “particularly adverse effects” on Kentucky and Pennsylvania, wrote Harvard health economics professor Richard Frank and Sherry Glied, dean of the Wagner School of Public Service at New York University.
Both states used the health care law’s Medicaid expansion to promote medication-assisted treatment for opioid abusers. Medicaid now pays for 35 percent to 50 percent of all medication-assisted treatment in Kentucky, the study found. In Pennsylvania, it’s 30 percent.
“They would find it much more challenging to maintain these evidence-based programs in the face of a repeal of those expansions,” Frank and Glied wrote.
“We estimate that approximately 1,253,000 people with serious mental disorders and about 2.8 million Americans with a substance use disorder, of whom about 222,000 have an opioid disorder, would lose some or all of their insurance coverage” under a repeal of Obamacare, Frank and Glied wrote.
The Medicaid expansion in Kentucky made substance-abuse treatment available to many more people and increased the depth and variety of services they can get, said Steve Shannon, executive director of the Kentucky Association of Regional Programs. The associations represents community mental health centers, which provide substance abuse treatment.
Shannon said there is a concern that eliminating the Affordable Care Act could mean less funding to help people battling addiction, which he contends is the top public-policy problem facing the state.
Whatever comes after the ACA must have a robust substance-abuse benefit, he said.
“That’s why the replacement piece is so significant,” Shannon said.
Nationally, the 21st Century Cures Act boosted funding for opioid treatment by $1 billion over two years and increased money to treat serious mental illnesses by about $200 million in 2017. The funding helped provide opioid treatment for about 420,000 people who need it but can’t access or afford it. Repealing the Affordable Care Act would increase that number by more than 210,000, Frank and Glied found.
“The human impact of repealing the Affordable Care Act cannot be overstated,” said a statement from Gary Mendell, CEO of Shatterproof, a nonprofit organization that fights addiction. “Four million Americans who are struggling with mental illness or substance use disorders would lose access to life-saving treatment and care if Congress moves forward with ACA repeal.”