GOP health care plan could harm anti-opioid efforts

The House GOP’s health care bill would leave 14 million fewer people on Medicaid and force other patients to pay thousands of dollars more for substance abuse treatment, analysts said, in what some lawmakers fear would be a major step backward in the national battle against opioid addiction.

Congress has poured hundreds of millions of dollars into opioid-fighting programs over the last year, but both Democrats and Republicans say those gains could be wiped out by the House bill’s rollback of Obamacare’s Medicaid expansion, and other changes.

“A lot of the young population that is being insured under the Medicaid expansion program has problems with either substance abuse or mental illness, and that’s one reason those of us who represent states where we have an epidemic of opioid and heroin abuse are particularly concerned about the impact of the Medicaid cuts,” Sen. Susan Collins, Maine Republican and a critical swing votes as the Senate tries to write its own health bill.

Ms. Collins’ state hasn’t yet expanded its Medicaid program, but it would be affected by caps on federal spending in the House plan dubbed the American Health Care Act.

Lawmakers said Mr. Trump himself vowed to fight the opioid epidemic during the presidential campaign, and wonder how his budget squares with those promises.

The administration says it is following through, citing a new commission on opioids and a state-by-state listening tour by Health and Human Services Secretary Tom Price.

Mr. Price is also cheerleading for National Institutes of Health research into new ways to treat pain or manage addiction.

Democrats, though, say the president’s legislative agenda is a bigger symbol, and it looks bad.

Besides reining in Medicaid, the Obamacare replacement plan that Mr. Trump celebrated in the White House Rose Garden would let states waive the slate of essential health benefits that insurers are required to cover, so people can opt for skimpier plans and pay less.

Those who need specific services such as drug treatment, though, could end up paying thousands of dollars more, the Congressional Budget Office said.

Richard G. Frank, a professor at Harvard Medical School, estimates there are 220,000 people who suffer from an opioid disorder and hold coverage through one of the two main pillars of the 2010 health care law — expanded Medicaid coverage or a taxpayer-subsidized plan on the exchanges.

He said Americans whose incomes would qualify them for either program are roughly 30 percent more likely to have a substance abuse problem than the rest of the population.

Mr. Trump’s budget for fiscal 2018 does reflect opioid-related spending that Congress passed on a bipartisan basis last year, through the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act.

Mr. Price recently sent to the governors of all 50 states announcing the first round of grants, worth $485 million in total.

The spending blueprint also maintains funding, at $1.85 billion, for Substance Abuse Prevention and Treatment block grants to the states.

“But that is only a fraction of what the cuts would be on the Medicaid side,” said Peggy Bailey, director of the health integration project at the left-leaning Center for Budget Priorities and Policy. “So while, sure, those grant funds are there to able to fill in gaps, it’s nowhere near as big as the Medicaid cuts that are proposed in the president’s budget. It’s like trying to cover a gunshot wound with a Band-Aid. It won’t work.”

The budget is only a request to Congress, and lawmakers have already said they’ll substantially rewrite the president’s blueprint. The Senate GOP, meanwhile, has started to write its own health care plan.

Sen. Rob Portman, an Ohio Republican who swept to reelection last year after making the opioid fight a key issue, recently urged the White House to reverse course and fund the Office of National Drug Control Policy, after its “skinny” budget threatened to gut it.

He is also among key Republicans who say the GOP must replace Obamacare with something that doesn’t foil the opioid fight.

“Rob has made clear he doesn’t support the House bill as is, and one of the reasons why is because it does enough to protect Ohio’s Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse,” Portman spokesman Kevin Smith said. “He is working with his colleagues on solutions to ensure that those who are impacted by this epidemic can continue to receive treatment under a new health care system.”