businessinsider.com: The Senate healthcare bill mentions the opioid crisis only once — but its effects could be devastating
6/29/2017
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Senate Republican leadership on Thursday released a draft of its long-awaited healthcare bill, the Better Care Reconciliation Act of 2017.
The bill contained only one mention of the ongoing opioid crisis: It appropriates $2 billion for fiscal year 2018 for the secretary of Health and Human Services "to provide grants to states to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders."
Tennessee Sen. Lamar Alexander has argued, among others, that the appropriation is "by far the largest amount Congress has ever appropriated in one year for opioids. But it pales in comparison to the $45 billion over 10 years for which Republicans like Ohio Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito reportedly asked.
It also doesn't account for the billions of dollars in funding for treatment and addiction services that could be lost due to other provisions of the BCRA, the Senate's bill.
The bill would have major effects on the opioid crisis — here's how:
Medicaid funding
The BCRA would phase out the Medicaid expansion established by the Affordable Care Act, which extended the program to those making between 100% to 138% of the federal poverty limit.
The Congressional Budget Office estimated in March that the Medicaid rollback under the AHCA would result in approximately 14 million people coming off the rolls in the next decade. The Senate's rollback isn't much different.
The CBO also estimated the House's bill would result in more than $800 billion in cuts to federal Medicaid spending over the next decade.
If the Senate's bill passes, the cuts would likely be hundreds of billions more, due to a small, but significant shift in the benchmark used to calculate funding for the program.
The proposed phaseout of Medicaid expansion led Nevada Sen. Dean Heller, a Republican, to come out in opposition of the bill on Friday.
"You have to protect Medicaid expansion states. That's what I want. Make sure we're taken care of here in the state of Nevada," Heller said.
Republican Gov. Brian Sandoval expanded Medicaid in Nevada, which has the 15th-highest drug-overdose death rate in the US. Sandoval said on Friday that expansion has led to 210,000 Nevadans gaining coverage.
Further, eight states that chose to expand Medicaid include provisions that would automatically end the expansion if funding changes.
Four of those states — New Hampshire, New Mexico, Michigan, and Indiana — are in the top 20 of states with the highest overdose death rates.
"This bill takes away the No. 1 tool we have in the fight against opioids — Medicaid treatment," Sen. Sherrod Brown, a Democrat from Ohio, said in a statement.
Medicaid has been integral to the fight against the opioid crisis in Ohio and elsewhere. In West Virginia, the state with the highest drug-overdose death rate in the US, and Ohio, which is third, Medicaid has paid for 45% and 49.5% of treatment costs, respectively, according to Stat News. It's similarly high in other states affected by the crisis.