Opioids Compromise is a Good Start, but Misses Most Important Opportunities to Battle the Epidemic
Washington, D.C.—This week, House and Senate leaders announced the completion of negotiations on bipartisan, bicameral opioids legislation – H.R. 6, the SUPPORT for Patients and Communities Act. The final bill contains many helpful reforms and negotiators wisely avoided providing a last-minute bailout to the pharmaceutical industry. Congress did not, however, authorize the significant federal resources – particularly through Medicaid – that are truly needed to end the unprecedented epidemic of substance use disorder (SUD) across the country.
At least 17 percent of people who are addicted to opioids are uninsured, a rate nearly 50 percent higher than the general population. Empirical evidence demonstrates that the most important tool available to help people with SUD is comprehensive health care coverage. Yet policymakers in 17 states have failed to expand their Medicaid programs to the very people most likely to suffer from SUD—lower-income adults. Moreover, leaders in more than a dozen states, in collaboration with the Centers for Medicare and Medicaid Services, are making it harder for people with SUD to access Medicaid by pushing unnecessary and burdensome Medicaid eligibility requirements. In at least one state, this would include drug testing Medicaid recipients.
Following is the statement of Frederick Isasi, JD, MPH, executive director of Families USA:
“Congressional leaders should be congratulated for reaching bipartisan agreement on legislation to address substance use disorder. It is always good to see bipartisan action on a critical issue, but let’s not fool ourselves. Despite its more than 600 pages and more than 200 individual sections, the bill misses the opportunity to provide the foundational means to truly stemming the tide of the substance use disorder epidemic – ensuring people suffering opioid addiction have access to comprehensive treatment, which includes medication, counseling, and other behavioral health services. That is only achieved when these friends and family have access to comprehensive health care, often through the Medicaid program.
“According to the National Institute of Health, substance use disorder costs the country more than $600 billion annually. In contrast, the legislation includes approximately $8 billion in new funding over five years to support substance use disorder prevention and treatment, based on earlier reports. But most of this funding isn’t available until Congress acts again to actually appropriate the funding. Seventy-one thousand people died in 2017 from substance use and at least 21.5 million children and adults suffer with substance use disorder. Even if Congress decided to fully fund the law – which is not a sure thing at all - this legislation would represent less than $100 per person per year to address one of the most important health issues facing our nation.
“Families USA supports H.R. 6, but we hope that Congress views it as simply the down payment on more comprehensive legislation in the near future.
“Even the most robust federal efforts to address the opioid epidemic will be stymied if state policymakers continue to refuse to provide Medicaid coverage to their constituents most affected by substance use disorder, and erect roadblocks to eligible recipients in the form of work requirements and drug testing.
“We are very pleased that congressional leaders stood strong in the face of significant pressure from the pharmaceutical industry and its legion of lobbyists in rejecting efforts to include provisions that would increase costs to seniors and other Medicare beneficiaries. Rejecting this last-minute effort indicates Congress is serious about putting constituents’ well-being before drug company profits.
“Further, we are pleased that the legislation includes a number of provisions which will help people who suffer from substance use disorder to find access to needed treatment. Among the most promising elements are an extension of enhanced federal funding for Medicaid health homes for recipients with substance use disorder, partial repeal of the Medicaid “IMD Exclusion” for people with substance use disorder, and increased flexibility for Medication-Assisted Treatment.
“Lack of intensive treatment capacity is a critical problem in efforts to confront this epidemic. Medicaid is the right funding vehicle to build capacity to treat substance use commensurate with the scope of the crisis. It is deeply disappointing that Republican leaders blocked any attempts to provide the significant ongoing Medicaid funding needed to control this epidemic.
“Despite the missed opportunity to improve coverage options for people with substance use disorder, it is not too late for Congress to build on the positive steps in this bill. We urge congressional leaders to prove that their focus on substance use disorder is more than just election year posturing and work swiftly to pass legislation that leverage’s Medicaid’s ability to build treatment capacity and puts serious resources behind efforts to stamp out substance use disorder.”