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WASHINGTON — A new study by Harvard Medical School and New York University shows that repealing the Affordable Care Act would cut $5.5 billion a year for substance-abuse and mental health treatment, creating a 50 percent spike in the number of people unable to address their opioid dependence.
The lost funding would have sweeping implications as deaths from opioid abuse continue to rise across the nation and local governments struggle with the effects on their communities.
Repeal without replacement of funds would have “particularly adverse effects” on states like Kentucky and Pennsylvania, wrote Harvard health economics professor Richard Frank and Sherry Glied, dean of the Wagner School of Public Service at New York University.
Both states used the health care law’s Medicaid expansion to promote medication-assisted treatment for opioid abusers. Medicaid now pays for 35 percent to 50 percent of all medication-assisted treatment in Kentucky, the study found. In Pennsylvania, it’s 30 percent.
“They would find it much more challenging to maintain these evidence-based programs in the face of a repeal of those expansions,” Frank and Glied wrote.
“We estimate that approximately 1,253,000 people with serious mental disorders and about 2.8 million Americans with a substance use disorder, of whom about 222,000 have an opioid disorder, would lose some or all of their insurance coverage” under a repeal of Obamacare, Frank and Glied wrote.
The 21st Century Cures Act boosted funding for opioid treatment by $1 billion over two years, and money to treat serious mental illnesses by about $200 million in 2017. The funding helped provide opioid treatment for some 420,000 people who need it but can’t access or afford it. Repealing the Affordable Care Act would increase that number by more than 210,000, Frank and Glied found.
“The human impact of repealing the Affordable Care Act cannot be overstated,” said a statement from Gary Mendell, CEO of Shatterproof, a nonprofit organization that fights addiction. “Four million Americans who are struggling with mental illness or substance use disorders would lose access to life-saving treatment and care if Congress moves forward with ACA repeal.”
In Florida, which fills 623 opioid prescriptions per 1,000 people, nearly 200,000 get substance abuse treatment through their marketplace coverage, the study found.
In Texas, it’s nearly 153,000, and nearly 28,000 in Missouri.
In all three states, care would be jeopardized if Affordable Care Act repeal slashes federal funding for the subsidies that help marketplace plan members pay their premiums.
In a statement, Linda Rosenberg, CEO and president of the National Council for Behavioral Health, said repeal essentially would leave states “to deal with their increasing addiction and death rates on their own. The opioid epidemic is already taking a massive toll in our communities, and if anything we need more resources, not less.”