Senate Republicans unveiled on Thursday their formerly secret plan to overhaul America’s health care system, and it’s already clear their proposal stands to make one of the country’s worst public health crises even worse.
The Better Care Reconciliation Act of 2017 would slash Medicaid funding and eliminate rules that require insurers to cover addiction treatment, moves that would likely exacerbate America’s terrible opioid epidemic, which now kills more people per year than car accidents and gun violence.
The Senate proposal would set aside $2 billion in the 2018 fiscal year “to provide grants to States to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders,” but that strategy is flawed because every state won’t choose the most effective approach for dealing with opioid addiction.
There’s an abundance of research that shows medically assisted treatments (MAT) such as the administration of methadone and Suboxone are the best way to help people get clean, but there’s still a stigma surrounding these methods because they’re seen as swapping one addictive substance for another. It’s extremely difficult for opioid users to get access to MAT in some conservative states, and that won’t change under the Republican plan.
“Just spending money on treatment is not enough,” said Leo Beletsky, associate professor of law and health sciences at Northeastern University. “You have to spend it on treatment that actually works.”
While $2 billion is a sizable chunk of change, Vivek Murthy, who served as Surgeon General from 2014 until he was asked for his resignation in April by President Donald Trump, says it’s actually far too little. Addiction treatment is only one piece of the puzzle; many drug users also have other health problems that need attention.
“Realistically, it won’t be enough to cover the vast numbers who would lose access to treatment,” Murthy said Thursday. “Even more important, such an approach ignores a fundamental reality that addiction is rarely an isolated condition. Many people living with substance use disorders need comprehensive insurance to treat related health conditions like chronic pain, anxiety, and depression.”
Every week seems to bring a grim new statistic about America’s opioid epidemic, and this week was no different. According to the World Drug Report released by the United Nations Office on Drugs and Crime (UNODC) — it was released the same day as the Senate Republicans’ health care plan — the U.S. now accounts for about one-quarter of all estimated drug-related deaths worldwide despite having less than 5 percent of the world’s population.
The report found that drugs cause about 190,000 premature deaths worldwide every year, with “the majority” of those attributable to overdoses caused by opioids such as heroin and fentanyl. In the U.S., overdose deaths more than tripled in 16 years, climbing from 16,800 in 1999 to 52,400 in 2015. There was an 11 percent spike in fatal overdoses from 2014 to 2015, and preliminary data projects an even larger surge — 19 percent — in 2016, when an estimated 59,000 deaths were caused by drugs. And it will likely get worse.
“The opioid crisis,” the U.N. report states, “shows little sign of stopping.”
Medicaid now provides health insurance to roughly 11 million low-income people in 31 states, including Ohio, Kentucky, and West Virginia, the places hardest hit by the opioid epidemic. About 29 percent of the people enrolled in the Medicaid expansion have mental health or addiction problems, and virtually all of those people could eventually lose health coverage under the Senate Republican plan.
Obamacare requires insurers to cover substance abuse treatment as an “essential health benefit.” The Senate Republican plan would do away with that requirement.
“Users can’t simply stop. They need treatment. They need medical advice. This takes time to be addressed.”
The U.N report notes that the opioid epidemic won’t subside until more drug users have access to treatment. It found that 29.5 million people around the world suffer from drug use disorders, but fewer than one in six have that access. Remarkably, the situation is even worse in the U.S., where only about 10 percent of people with a substance use disorder receive any type of specialty treatment.
The U.N. report adds to the consensus that America’s soaring overdose rate is linked to fentanyl, a synthetic opioid about 50 times stronger than heroin. Fentanyl and its even more powerful cousins, such as the elephant tranquilizer carfentanil, have been blamed for a surge in fatalities in states across the country; the drugs are increasingly being mixed with heroin or sold as counterfeit prescription pills.
So far, the fentanyl problem and the corresponding flood of overdoses has been limited to North America, but Martin Raithelhuber, a synthetic drugs expert at UNODC headquarters in Vienna, told VICE News that synthetic opioids have been turning up more often in Europe.
“It’s a new phenomenon,” he said. “We’ve seen that mainly since 2013 here and there, but we can clearly see an increase in the number of countries reporting [seizures of] these substances in the last two years.”
Europe, however, has not seen nearly the same number of deaths due to opioid overdoses as the United States. It’s hard to pin the disparity on just one factor, but Raithelhuber noted that access to quality health care is likely key. It’s not enough, he said, to just crack down on the supply of opioids by shutting down pill mills and trying to curb illicit fentanyl production.
“We’re talking about many users who have a substance use disorder, meaning they’re dependent on opioids,” Raithelhuber said. “They can’t simply stop from one day to the other. They need treatment. They need medical advice. This takes time to be addressed. Any policy may want to look at different aspects of the issue.”
There’s no telling yet what kind of health care bill might eventually land on Trump’s desk; hours after the Senate version was unveiled, four Republican senators had already said they wouldn’t vote for it, putting its passage in jeopardy. But whatever form the bill eventually takes, chances are it won’t just have detrimental health effects on Americans — it will have political ramifications for Republicans.
Beletsky points out that the Medicaid cuts could backfire for senators in states where the opioid epidemic is raging. Trump pledged to “take care” of the crisis, but eliminating health care and reducing access to drug treatment may leave voters in states like Michigan and Ohio disgruntled during the next election.
“It’s political suicide as well as mass homicide,” Beletsky said. “[Voters] trusted the campaign promise that Trump would be addressing this crisis head on. Enacting policies that are pretty much guaranteed to make the crisis worse… seems extremely short-sighted.”