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June 21, 2017

Adding Insult to Injury: The AHCA and Opioid Addiction

Opioid addiction has become a crisis nationwide and in cities and counties across Virginia. In the U.S., the number of opioid related deaths has nearly quadrupled in less than two decades, and more than 1,400 Virginians lost their lives to opioids in 2016.

But while the epidemic has been worsening, Republicans in Congress have been busy working on legislation that will prevent those with substance use disorders or mental illness in general from being able to get life-saving medical help. The American Health Care Act (AHCA) could limit insurance coverage for substance use disorder treatments or cause exorbitant premium increases for those benefits, leaving tens of thousands of Virginians without meaningful access to treatment. The House has already passed its version of the AHCA, and the Senate may vote on its bill as early as next week.

Here are the facts:

People needing substance use disorder and mental health care treatments were generally underserved prior to the Affordable Care Act (ACA). Health insurance plans often did not provide coverage for Substance Use Disorder (SUD) treatments, or offered only very limited benefits.

The ACA established a federal minimum for what private insurers must cover for 10 “Essential Health Benefits” (EHBs) including substance use disorder and mental health treatment, providing millions with access to SUD treatments.

The efforts to repeal and replace the ACA from both the House and the Senate will put all of these gains on the chopping block. Like the House version of the AHCA, the Senate bill will likely allow states to strip away EHBs. The Congressional Budget Office (CBO) determined that, when EHB standards aren’t required, mental health and SUD treatments are one of the most likely to be dropped. Yet, mental health conditions and substance use disorders are among the most common pre-existing conditions, affecting more than 1.3 million adults in Virginia between 18 and 64.

U.S. Senate Republicans are touting that their legislation would not allow insurers to deny coverage to people with pre-existing conditions. But saying that people would not be denied coverage is not the same as saying people would be able to receive needed treatment. Costs for plans without EHBs might be lower, but plans that continue to cover them would have extremely high premiums as well as higher out-of-pocket expenses (since mostly individuals with pre-existing conditions would be likely to enroll in them).

Removing the protections of the EHB coverages is not all that the AHCA bills would do to limit access and coverage for treatment for opioid addiction and other substance use disorders. The AHCA proposals would also weaken the structure and financing of Medicaid. It’s not just the sharp projected cuts in funding; under a per-capita cap Virginia would receive only a fixed amount of federal funds for Medicaid, even if medical expenses increased sharply (due to an addiction-related public health crisis, for example). Medicaid and the Children’s Health Insurance Program are particularly important because these programs cover 3 in 10 people with opioid addiction.

At least 40,000 people in our state’s Medicaid program have a substance use disorder. And for these Virginians, access to life-saving opioid treatments is a matter of life and death. The U.S. Senate should reject the AHCA or any piece of legislation that reduces coverage and critical substance use disorder treatments.  

This is the fourth in a series of blog post highlighting the impact of the American Health Care Act on Virginia. For more information about this post, please contact Kenneth Gilliam at To read previous posts in this series, click on the links below.

Bad Medicine: AHCA provisions would be hard for older adults to swallow

Bad Medicine: AHCA would be a bitter pill for rural communities

Top 5 Reasons Why the AHCA Would Harm Rural Hospitals and Communities

Kenneth Gilliam

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