Pubdate: Tue, 20 Jun 2017
Source: Honolulu Star-Advertiser (HI)
Copyright: 2017 Star Advertiser


WASHINGTON - The Republican drive to roll back Barack Obama's health
care law is on a collision course with a national opioid epidemic
that's not letting up.

Medicaid cuts resulting from the GOP legislation would hit hard in
states deeply affected by the addiction crisis and struggling to turn
the corner, according to state data and concerned lawmakers in both

The House health care bill would phase out expanded Medicaid, which
allows states to provide federally backed insurance to low-income
adults previously not eligible. Many people in that demographic are in
their 20s and 30s and dealing with opioid addiction. Dollars from
Washington have allowed states to boost their response to the crisis,
paying for medication, counseling, therapy and other services.

According to data compiled by The Associated Press, Medicaid expansion
accounted for 61 percent of total Medicaid spending on substance abuse
treatment in Kentucky, 47 percent in West Virginia, 56 percent in
Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In
Ohio, the expansion accounted for 43 percent of Medicaid spending in
2016 on behavioral health, a category that includes mental health and
substance abuse.

Those states accepted the Medicaid expansion and represent a
cross-section of places hardest hit by the overdose epidemic, which
claimed more than 52,000 lives nationwide in 2015. Of the deaths, more
than 6 in 10 were due to opioids, from prescription pain relievers
like oxycodone to street drugs like heroin and an elephant

Tracy Plouck, Ohio's director of mental health and addiction services,
said Medicaid expansion dollars from Washington have allowed her state
to redirect its own resources to priorities like providing recovery
housing after detox. Reversing that would have real consequences for
people who are trying to straighten their lives out. "If you go back
into an environment where people are using, that sets you up with a
risk that's nearly insurmountable," Plouck said.

In Youngstown, Ohio, factory mechanic Paul Wright credits sustained
help from Medicaid with his survival after he nearly died from a
heroin overdose. Wright said he had started using as a teenager and
has been drug-free now for 18 months. Before Medicaid expanded, his
father's health insurance would pay for detox, but not for long-term
treatment. Wright would relapse. With Medicaid, he's been able to get

"It's truly sad, but I've been to many funerals since I've been
clean," said Wright, who's in his mid-20s. "I just think Medicaid -
honestly - it saves people." And he's able to work.

The House GOP bill would end the extra funding states get through
expanded Medicaid in 2020, and place a limit on overall federal
spending for the program in the future. People already covered like
Wright would be grandfathered in as long as they continue to meet
eligibility requirements. But that's no comfort to Carolyn Givens, who
runs the Neil Kennedy Recovery Center, where Wright gets help.

"If somebody could say to me, 'Carolyn, the crisis is going to be over
next week,' I'd feel OK - but I got 40 people on a waiting list,"
Givens said.

Medicaid cuts have become a major sticking point in the Senate for the
GOP's American Health Care Act. Republican leaders can only afford to
lose two votes, and several GOP senators from hard-hit states have
been critical. Sen. John Thune, R-S.D. said Tuesday that senators are
considering extending the phase-out by three years, to 2023.

At a recent budget hearing, Health and Human Services Secretary Tom
Price defended the Trump administration and raised questions about how
much difference Medicaid actually makes.

The HHS budget for the opioid crisis is more than three times greater
than two years ago, $811 million versus $245 million, Price said. That
reflects increases approved by Congress beyond what Medicaid spends.

Questioned by Sen. Patrick Leahy, D-Vt., about the consequences of
reducing Medicaid's commitment, Price responded that more government
spending is not the answer.

"Let me respectfully suggest ... that the programs that are out there
by and large are not working," Price said. "We are losing more
Americans today than we did last year ... clearly we're moving in the
wrong direction."

Price suggested that states would be more effective with the greater
flexibility promised by the GOP plan for Medicaid.

Said Leahy: "As a child I believed in the tooth fairy, but I'm a little 
bit older now."

Sen. Jeanne Shaheen, D-N.H., said it's too early to expect a
turnaround in the epidemic. "The resources are just getting to the
communities," she said.

In New Hampshire, "we're just beginning to see the benefits of having
the expansion of Medicaid to provide treatment for people," Shaheen

Sen. Shelley Moore Capito, R-W.Va., wasn't convinced either. "I'm
having trouble, as many of us are, reconciling your stated goal (about
the opioid crisis) being one of your top three priorities with these
dramatic cuts, " she said to Price during the hearing.

Cutting financing for the Medicaid expansion "would create an
unsustainable financial obligation" for West Virginia, said Allison
Adler, a spokeswoman for the state's health department.

Back in Youngstown, recovering addict Niki Campana says "it's like the
apocalypse around here." Campana is helping other women with drug problems.

"I work with a lot of girls that struggle," she said at the Kennedy
treatment center. "We can get them on Medicaid in a day and get them
in treatment. For that not to be able to happen, that would be horrible."
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