WASHINGTON ― During his term as the director of the White House’s Office of National Drug Control Policy, Michael Botticelli argued that the end of the opioid epidemic would not come about through arrests.
To deal with this crisis ― which has led to record numbers of overdose deaths across the country ― the medical community would need to step up, Botticelli said.
Now, Botticelli, whose final day in office was last Friday, has warned that repealing the Affordable Care Act would roll back whatever fragile progress has been made toward that goal.
The ACA requires not only that addiction treatment be covered by health insurance policies, but that the coverage be on par with other treatments for chronic diseases. Together with the Medicaid expansion, the ACA has also helped states like Vermont fund state-of-the-art diversion programs. In Maryland, it has helped treatment facilities better integrate primary and mental health care.
A repeal of the ACA, as President Donald Trump has promised, would mean disaster for public health officials fighting the opioid epidemic, and for people who are addicted and looking to get treatment.
“I think there is a tremendous amount of fear that we are going to retreat from all of the science and evidence that we know to be true about addiction,” Botticelli told The Huffington Post last week, as the end of his tenure drew near.
Some states that were hit hardest by the epidemic have seen substantial increases in treatment access. According to Health and Human Services data, more and more people are coming into care with insurance.
“In states that expanded Medicaid under the ACA, the uninsured share of substance use or mental health disorder hospitalizations fell from about 20 percent in the fourth quarter of 2013 to about 5 percent by mid-2015,” HHS noted.
And among adults with low incomes, the Medicaid expansion led to an 18.3 percent reduction in unmet needs for drug treatment, the department found.
Mental health issues are common among people who struggle with an opioid addiction. The cost of such care has typically been a barrier. But HHS reported that “the share of people foregoing mental health care due to cost has fallen by 33 percent for people with incomes below 138 percent of the poverty level and by 31 percent for people with incomes above 138 and below 400 percent of the federal poverty level.”
As more people signed up for health insurance, they then sought out what is considered evidence-based drug treatment. In other words, the ACA worked as intended. In Ohio, Harvard data shows that almost 50 percent of the spending on buprenorphine ― a medication that has been shown to help prevent overdose deaths ― was paid for by Medicaid last year. In West Virginia, Medicaid covered nearly 45 percent of the spending on buprenorphine. This medication, along with methadone, is widely considered by medical experts to give people addicted to opioids the best chance at recovery.
“Our response to this opioid epidemic has largely been focusing on ‘How do we narrow that treatment gap?’” Botticelli said. “And certainly one of the biggest contributors to narrowing that treatment gap is making sure that people get insurance coverage and have adequate insurance coverage for substance use disorders… We know that care and coverage has been essential to dealing with the epidemic.”
The now-former drug czar added: “I think there’s ample evidence to suggest that those states that have been significantly burdened by the opioid epidemic will be more significantly impacted because of any potential repeal of the ACA.”
If Trump and Congress kill the Affordable Care Act, Botticelli worries about how it would affect people currently in treatment. What would it mean for the people paying for buprenorphine through Medicaid? What it would mean for those in a long-term residential program that they’re paying for with health insurance they got via the ACA? And what would it mean for providers who exist because of Medicaid payments?
“Providers and people in the field that I’ve talked to are really significantly concerned,” Botticelli said. “[We’ve] just really started to make progress on this issue, both in terms of care and coverage, in dealing with this as a public health-related issue.”