Under the Affordable Care Act, Medicaid drastically expanded addiction and mental health services to those who could previously not afford insurance. According to the Substance Abuse and Mental Health Services Administration, Medicaid is now the single largest payer of mental health services in the country, paying 25 percent of all mental health and 20 percent of all addiction care.
By covering low-income childless adults up to 138 percent of the federal poverty line, the Medicaid expansion enabled 1.29 million low-income people with substance use disorders to gain access to coverage that is unavailable to their peers in non-expansion states. Tens of thousands could and did receive treatment thanks to the ACA and Medicaid expansion.
Yet, despite the positive results of Medicaid expansion, there are those in Congress who want to eliminate it. We saw this with the introduction of the American Health Care Act. The AHCA would have capped federal payments to state Medicaid programs and eliminated many subsidies that help low-income people obtain coverage. The bill also included a provision allowing states to drop mental health and addiction services from their Medicaid plans. Given that before the ACA required them to be included many states had dropped them, it is likely they will be dropped again, leaving many individuals with mental illness and addiction without access to treatment.
According to an analysis by Harvard Medical School and New York University researchers, the ACA expanded access to care for 2.8 million Americans with drug use disorders. Eliminating Medicaid expansion could leave millions of people struggling with addiction stranded without potentially lifesaving care, driving up costs in emergency room visits and hospital stays.
If that is the case, another issue under discussion should be what would the cost of taking coverage away be? Thirty-one states adopted Medicaid expansion and the data shows millions of people are benefiting from it. Without treatment options, how can the U.S. tackle the opioid epidemic that worsens every day? How can we ensure an adequate safety net with capacity to meet our country’s growing need? Of the 20 million Americans diagnosed with a substance abuse disorder in 2015, two million had a disorder involving prescription pain relievers and 591,000 had ones involving heroin, according to the American Society of Addiction Medicine. Drug overdose is now the leading cause of accidental death in the US far exceeding those from automobile accidents and firearms.
The Congress that invested in the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act can and must build on our nation’s progress and operationalize these and other bipartisan efforts. They must consider the human and societal costs of eliminating treatment options, in addition to budget considerations.
As replacement discussions continue over the next couple of weeks and as the nation faces an opioid epidemic that requires a full continuum of chronic care services and as we continue to build an adequate mental health safety net to have policies in place that serve all those that need it we must remain vigilant and remember that access to affordable health care is about saving people’s lives.
Chuck Ingoglia is chairman of the board of directors for the Mental Health Liason Group.
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