BEYOND THE NUMBERS
Even with Health and Human Services Secretary Tom Price visiting states to learn about the opioid epidemic and President Trump launching a commission on Combating Drug Addiction and the Opioid Crisis, the President is proposing budget cuts and policy changes that would undermine access to substance use disorder (SUD) treatment and hamstring efforts to address the epidemic.
Price has highlighted the efforts of first responders, judges, and community leaders. But the admirable programs he highlights can’t do it alone. They don’t provide professional treatment services critical to effectively combatting the opioid epidemic such as detox, recovery supports, medically assisted treatment prescriptions, or other evidence-based treatment strategies. Increasingly, Medicaid covers the cost of these SUD services.
But Trump and congressional Republican proposals would make it much harder for Medicaid to cover these treatments. Among the proposals:
- The President’s budget would cut federal Medicaid spending by as much as $1.3 trillion over the next ten years (see chart) — or by 45 percent in 2026, compared to current law.
- The House-passed Republican health bill to repeal and replace the Affordable Care Act (ACA), which the President embraced in his budget and which contributes to the Medicaid cut cited above, would reduce Medicaid enrollment by 14 million by 2026.
The House bill would end Medicaid as we know it by converting it to a per capita cap or, if a state prefers, a block grant and effectively eliminate the ACA’s Medicaid expansion. These steps would increasingly shift costs to states which, as a result, would likely cut their Medicaid programs to cover the costs, such as by reducing coverage for people with SUDs. The basic Medicaid program isn’t required to cover SUDs and some of the recent significant coverage increases for SUDs came as a result of the ACA’s Medicaid expansion. (About 12 percent of all Medicaid beneficiaries have a substance use disorder.)
Moreover, the House bill’s repeal of the ACA’s major coverage provisions would cut at least $5.5 billion a year from mental health and substance use disorder treatment, research shows. The bill would also let states eliminate or roll back the ACA’s requirement that insurers in the individual market cover “essential health benefits” including SUD services, which would jeopardize coverage of substance use treatment for millions of people buying individual market coverage.
- Price and Centers for Medicare & Medicaid Services Administrator Seema Verma have indicated that they’re willing to let states use waivers to impose barriers to Medicaid coverage, including work requirements, premiums and cost-sharing, and drug testing that would make it harder for low-income beneficiaries with SUDs to maintain their coverage and access to treatment.
The President’s budget purports to address the opioid epidemic. But its modest $56 million increase for medically assisted treatment strategies — even coupled with $1 billion over the next two years in federal funding for SUD services in the 2016 Comprehensive Addiction Recovery Act and the 21st Century Cures Act — can’t fill the gap that these deep Medicaid cuts would leave.
“[W]e’re looking up and down the federal government,” Price recently wrote, “and asking ourselves what we can do — and what we can do better — to amplify and support the work of the men and women on the front lines of this battle.” Policymakers can do much to improve access to SUD treatment and address the opioid epidemic, but the solutions don’t include the President’s deep Medicaid cuts and steps that would weaken health insurance coverage.