The newly unveiled replacement of Obamacare has been hastily produced by the Republicans, but is already under attack from Democrats and other Republicans. GOP governors are warning that the Trumpcare proposals could have catastrophic implications for those in the fight to stop the surge in opioid overdoses.

• 29 percent of those enrolled in Medicaid expansion have mental health or addiction problems.
• Analysis by Standard & Poor’s estimates that six to 10 million Americans could lose coverage.
• Ironically the loss of addiction assistance will affect those most in rural areas, Trump’s base.

It’s long been a desire of Republicans to cut the funding for Medicaid, limit enrolment and abolish rules that require coverage for both mental health and substance abuse treatment. Trumpcare would do just that; slowly rolling back the Affordable Care Act’s expansion of Medicaid, which currently provides insurance to around 11 million low-income people in 31 states.

Disastrous effects for those struggling with addiction

“Phasing out Medicaid coverage without a viable alternative is counterproductive and unnecessarily puts at risk our ability to treat the drug-addicted, mentally ill, and working poor who now have access to a stable source of care,” Ohio Gov. John Kasich said Tuesday.

Drug policy experts have said that the proposal goes even further, that the changes to Medicaid and other parts of the plan could exacerbate the opioid crisis.

This plan would be a disaster for individuals who are struggling with problematic drug use, currently enrolled in treatment services, or would want to be,” said Emily Kaltenbach, the Drug Policy Alliance’s senior director of national criminal justice reform strategy.

Of the people currently enrolled in the Medicaid expansion, about 29 percent have mental health or addiction problems, and virtually all of them could lose health coverage if Congress approves the current version of the healthcare plan.

“Grand irony”

Leo Beletsky, an associate professor of law and health sciences at Northeastern University, said the “grand irony” of Trumpcare is that it will touch Trump’s base – those in rural areas who would be most affected by the loss of addiction treatment resources.

They really stand to benefit most from the Medicaid expansion,” Beletsky said. “Unfortunately, it’s going to add fuel to the fire in those areas where they’re already getting completely devastated.”

The proposed changes to Medicaid isn’t the only part of Trumpcare that will impact the effort to combat opioid addiction, the Congressional Budget Office is yet to number crunch the proposal and reveal how much it will cost and the implications of said cost, but analysis by Standard & Poor’s estimated that six to 10 million Americans could lose coverage.

Downstream negative public health consequences

Brendan Saloner, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, said that Trumpcare would include changes that will allow insurance companies and state Medicaid plans to reject drug users.

“They’re going to be engaging in a lot of tactics to essentially repel people from enrolling in their plans if they think they have high-cost conditions like substance use disorders,” Saloner said. “I anticipate there’s going to be a lot more discrimination and a lot more potential for people with substance use disorders to fall through the cracks.”

These cuts to Obamacare could therefore result in fewer people receiving treatment creating negative public health consequences that will cost US taxpayers more in the long run.

“When someone has a substance use problem and they’re not getting help, what you see is they’re often not holding a job, which means there’s less economic productivity,” Saloner said. “They’re at higher risk of getting in motor vehicle accident. They’re at a higher risk of going to jail or prison, which is a high cost to taxpayers.”

Despite the significant gains in health coverage under Obamacare, drug addicts still remain sadly under-treated, with only 10 percent of those with substance abuse disorders receiving any kind of specialty treatment.

We know people are more likely to seek and receive treatment for substance misuse disorders if they have health insurance. If they don’t have insurance, there’s no fallback. There’s no safety net except for emergency care.

The plan would also make doctors more likely to prescribe opioids for chronic pain patients, since insurers won’t cover alternative treatments like acupuncture, massage, and physical therapy.