BEYOND THE NUMBERS
As the Senate Health, Education, Labor, and Pensions Committee meets tomorrow on the federal response to the opioid epidemic, it should consider the recent Government Accountability Office (GAO) report showing that the Affordable Care Act’s (ACA) Medicaid expansion is providing essential mental health and substance use disorder treatment. And while the committee discusses how to support states’ efforts to combat the opioid epidemic, the Republican majority in Congress should end its efforts to repeal the ACA, which would undermine access to care for millions of people struggling with mental health and substance use disorders.
The report shows that the Medicaid expansion has been critically important for low-income adults in the four expansion states that GAO studied: West Virginia, Iowa, New York, and Washington. GAO found that:
- A large share of newly enrolled beneficiaries used mental health or substance use disorder treatment in 2014. Between 20 and 34 percent of Medicaid expansion beneficiaries used behavioral health services in the four states, including psychotherapy, diagnostic services, and prescription drugs to treat a mental health or substance use disorder.
- State officials credited the expansion with increased access to behavioral health treatment. Officials in West Virginia, Iowa, and Washington said that expansion beneficiaries likely had greater access to care after enrolling in Medicaid. (New York covered poor and low-income adults before 2014 and, therefore, saw less of a change in access to care.) West Virginia officials reported a higher use of medication-assisted treatment for substance use disorders among newly eligible beneficiaries, noting that the state’s charity care program on which uninsured residents relied before the expansion doesn’t pay for behavioral health prescription drugs. Uninsured individuals may have “relied on family members or may have sold personal belongings to afford their medications,” West Virginia officials said.
- Medicaid’s comprehensive coverage is essential for people with behavioral health conditions. Between 42 and 57 percent of expansion enrollees with a behavioral health diagnosis had an emergency room visit, compared to 13 to 32 percent of enrollees without such a diagnosis. However, the vast majority (between 81 and 92 percent) of emergency room visits by those with a behavioral health diagnosis were not mainly due to their mental health or substance use disorder. That’s likely because people with behavioral health conditions are likelier to have complex health needs. Medicaid’s comprehensive coverage provides treatment and care management, and many states provide greater coordination of care for people with multiple physical and behavioral health conditions, in contrast to the patchwork of uncoordinated care typically available to the uninsured. Limited funding for opioid treatment — without the Medicaid expansion — would leave many people without the care they need.
States need every available tool to help fight the opioid crisis as well as prevent and treat future public health crises. Repealing the Medicaid expansion would eliminate essential tools for states fighting the opioid epidemic, and it would put mental health and substance use treatment out of reach for millions of people who are in the fight of their lives.