US President Donald Trump has declared the opioid crisis a public health emergency. What that means in practice remains to be seen – possibilities include increased federal funding, inter-agency coordination, and improved rural health services. But one prerequisite to making real progress in stopping the 142 deaths that happen each day in the US from drug overdose, as well as the economic loss related to such high addiction rates, is ending the White House and the Republican Party’s war on the Affordable Care Act (ACA) and Medicaid.
The Mental Health Parity and Addiction Equity Act requires insurers, both public and private, to insure most mental and behavioral health services on an equal footing with other medical conditions. The ACA strengthens that mandate in numerous ways, such as making mental health care an “essential health benefit” that must be included in private insurance plans on the exchanges. Along with the expansion of Medicaid in 32 states under the ACA, these provisions form a foundation that is absolutely essential to addressing the opioid epidemic simply by increasing access to treatment for drug dependence.
Currently, more than 20 million adults are suffering from substance abuse. Yet fewer than 12 percent are receiving treatment. Under Medicaid expansion alone, 1.2 million people who were previously uninsured have gained access to drug treatment. If the remaining states expanded Medicaid, it is estimated that another 1.1 million people who are addicted to drugs would gain access to drug treatment.
The White House and some Congressional leaders, however, continue to undermine the ACA and are proposing devastating cuts to Medicaid. Trump’s recent executive order permits alternative health care plans to not be subject to ACA regulations like the mental health parity mandate. The Senate budget resolution proposes massive cuts to health care including a 1.3 trillion dollar cut in Medicaid by 2027. Trump said “This can be the generation that ends the opioid epidemic.” But without access to health services, including drug treatment, this goal will never be realized.