Pubdate: Fri, 07 Jul 2017
Source: Chicago Tribune (IL)
Copyright: 2017 Chicago Tribune Company
Author: Clarence Page


An council member in Middletown, Ohio, has asked the city's attorneys
to look into whether the city has a legal obligation to provide
ambulance service to repeat opiate overdose patients.

An council member in Middletown, Ohio, has asked the city's attorneys
to look into whether the city has a legal obligation to provide
ambulance service to repeat opiate overdose patients. (Brendan

Americans often complain that Washington debates seem to be far
removed from the lives of real people.

But Washington's health care debate and the nation's opioid crisis
became quite real to me in new ways after a city council member in the
Ohio town where I grew up made national news by raising a provocative
question: Does the city have to respond to calls from repeat opiate
overdose patients?

Morality aside -- and that's pushing a lot aside -- it's a good
question, especially in a town with a local government struggling to
make ends meet.

Middletown, Ohio, my old hometown, is faced with that challenge. The
once-thriving factory town that I recall has become a textbook case of
post-industrial job loss. And it has one of the highest opioid
overdose rates in a state with the fourth-highest rate in the nation,
according to the Centers for Disease Control and Prevention.

The city of about 50,000 has seen almost 600 overdoses this year.
That's more than in all of 2016. Ambulance crews say they're
responding to as many as four or five calls a day.

And the cost is soaring. Addiction treatment programs add up to more
than $2 million, or 10 percent, of the city's annual tax revenue,
spokesmen say.

Fearing a fiscal train wreck, council member Dan Picard asked the
city's law department to investigate whether the city has a legal
obligation to respond with ambulance service to repeat opiate overdose

If it does not, Picard has suggested a three-strikes policy: The first
two times someone overdoses, they would have to pay the city back for
the cost by performing community service. If they overdose a third
time without having repaid their debts from the first two, no
ambulance would come.

That's pretty drastic. The thought of barring ambulance crews from an
overdose patient who hasn't paid all of his or her fees reminds me of
another unsettling story: In 2010, firefighters in rural Obion County,
Tenn., were ordered to stand aside and let a home burn to the ground.
The homeowner hadn't paid a $75 fee to receive fire coverage provided
by the nearby town of South Fulton.

Picard's suggestion quickly went viral, attracting "hate mail,
national news coverage and overloaded voice mail and email inboxes,"
wrote City Manager Doug Adkins in his blog.

But as Adkins went on to point out, "nothing has changed aE& at all
aE& whatsoever. We are responding to every call and rendering aid as
needed. We give Narcan where it is appropriate. Period." Narcan, also
known by the generic name Naloxone, blocks the effects of opioids in
overdose patients.

One reason Picard's idea went viral is that the U.S. Senate is
considering a Republican-backed measure to repeal and replace the
Affordable Care Act, also known as Obamacare.

In his quest to secure 51 votes, Senate Majority Leader Mitch
McConnell added $45 billion to combat the opioid crisis. The move
aimed to attract the votes of moderate Republican Sens. Rob Portman of
Ohio and Shelley Moore Capito of West Virginia.

The earlier version of the bill provided only $2 billion in grants to
address the crisis. But Portman and Capito are still not on board.
They remain concerned about the deep cuts that original legislation
would make to Medicaid, cuts that the Congressional Budget Office
estimates would take $772 billion from Medicaid and coverage away from
15 million people.

Ohio's Republican Gov. John Kasich said last week that he warned
Portman that even the $45 billion wouldn't come close to making up for
the damage caused by the Medicaid cuts in the bill.

An earlier analysis by Richard Frank and Sherry Glied of New York
University estimated that repealing the ACA would cause 2.8 million
Americans with substance abuse disorders -- including about 222,000
with opioid problems -- and 1.3 million with serious mental disorders
to lose some or all of their insurance coverage.

That puts Congress in a position not unlike leaders back in Middletown
and other communities in similar predicaments. Both have to make
life-or-death decisions about their resources in the face of an opioid
crisis. The local folks happen to live and work closer to those who
need the help.
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