The Senate has an opportunity to address opioid epidemic: But first it must reject the AHCA

Every day, 144 people die of a drug overdose in this country. Over 22 million people are in need of treatment for their use of drugs and alcohol. One in every three families is affected by addiction. Children are losing parents. Parents are losing children. In red states and blue states, the opioid epidemic is seen by voters and politicians alike as one of the most urgent problems facing our nation.

As the Senate considers potential healthcare reform legislation, it has an extraordinary opportunity to change the trajectory of this public health crisis by adopting policies that dramatically reduce addiction in our nation. The imperative to do so is clear and pressing.


Fortunately, there is a strong foundation of bipartisan efforts to expand the health responses to addiction to build on. Over the past decade, Congress has enacted and presidents have signed a series of important reforms, including the Mental Health Parity and Addiction Equity Act, various provisions of the Affordable Care Act, the Comprehensive Addiction and Recovery Act, and the 21st Century Cures Act, that together address substance use disorders and mental health on a par equal to physical illnesses for the first time.

Unfortunately, the American Health Care Act passed by the House Representatives on May 4, 2017 would seriously undermine these advances. Should the bill become law, it would cripple our national response to the opioid epidemic by ending the Medicaid expansion, cutting $880 billion in federal Medicaid funds, and radically changing the structure of the program through federal funding caps. The impact would be widespread and devastating. If the AHCA was enacted, the states that expanded Medicaid services (31 states plus D.C.) would face a funding shortfall of $253 billion over ten years. Most states will not be able to make up the lost funding, which would result in millions of people losing their coverage. Nearly 30 percent of people covered through the Medicaid expansion need mental health or substance use disorders services.

But the American Health Care Act goes beyond just reducing access to addiction care under Medicaid. By dramatically weakening consumer protections for people with pre-existing conditions (including addiction), the AHCA would fundamentally change the way insurers cover substance use and mental health services across the board, taking us back to the time when insurers could discriminate against people based on their medical histories, and making commercial insurance unaffordable to millions.

According to the latest Congressional Budget Office calculations, under the AHCA as written, an additional 23 million Americans will be uninsured by 2026. Furthermore, the CBO report affirms that since states could waive the requirement notes that by removing the requirement that plans cover certain ‘Essential Health Benefits’, the current legislation would dramatically increase the out-of-pocket costs for people with excluded services. The report notes that “in particular, out-of-pocket spending on maternity care and mental health and substance use services could increase by thousands of dollars”. This additional burden would make treatment inaccessible to far too many people who desperately need it.

As the Senate develops its approach to healthcare reform, it should seek to maintain and, indeed, improve current healthcare laws and policies regarding addiction prevention and treatment. Key elements of such a policy should:

  • Maintain the current structure of the Medicaid program, a critically important safety net program for adults and children with addiction and mental healthcare needs, and continue the Medicaid expansion;
  • Maintain the requirements for Medicaid and commercial insurance to cover the Essential Health Benefits, including substance use disorder and mental healthcare at parity with other illnesses;
  • Retain protections for people with pre-existing conditions; and
  • Maintain and increase premium and cost-sharing subsides to make private insurance coverage more affordable.

As we continue to calculate the devastating costs of the opioid epidemic – in both human and economic terms – one thing is clear: we cannot afford to lose any more ground in our national efforts to stem the crisis. 

We urge the Senate to not simply reject the AHCA but instead to build on strong bipartisan efforts to effectively serve the one in three Americans who are affected by addiction. To do anything less would be to surrender millions of Americans to a public health crisis we can and must address. The health of our nation depends on it.

Tom McLellan is the former Deputy Director of the White House Office on National Drug Control Policy, and Founder of the Treatment Research Institute. Paul Samuels is the President and Director of the Legal Action Center.

The views expressed by this author are their own and are not the views of The Hill.