Van Hollen: Trumpcare Disastrous for Battle Against Opioid Crisis

With 91 Americans dying each day from an opioid overdose, U.S. Senator Chris Van Hollen joined Senator Edward J. Markey (D-Mass.) and 19 colleagues in sending a letter to Senate Majority Leader Mitch McConnell (R-Ky.) calling on him not to take up any legislation that would further harm individuals struggling with an opioid use disorder. The repeal of the Affordable Care Act could strip health care coverage from 2.8 million Americans suffering from a substance use disorder. The House legislation up for vote this week, The American Health Care Act, would upend coverage for the 1.3 million Americans who access behavioral health care services as a result of Medicaid expansion through the health care law. In the letter, the senators point to the fact that 12 percent of adult Medicaid beneficiaries live with some form or a substance abuse disorder, and Medicaid finances one-third of the medication-assisted treatment administered for opioid and other substance use disorders in the country.

In Maryland, opioid overdoses now rank with cancer, strokes and heart attacks among the top killers, and overdose deaths have increased dramatically in recent years. Senator Van Hollen has been fighting to help states get the upper hand on this public health crisis. Senator Van Hollen fought to pass the Comprehensive Addiction and Recovery Act, a bipartisan bill which was signed into law in July 2016 by President Obama.

"The bill removes the requirement that insurers provide minimum levels of coverage for the cost of covered services, which will mean that consumers will have to pay more out-of-pocket for their health care needs. This, coupled with insufficient premium tax credits, the repeal of the cost-sharing subsidies, and high-risk pools, will substantially hinder access to care for those with mental health and substance use disorders," write the senators in their letter to Leader McConnell. "Given that lack of insurance coverage and an inability to afford care often result in individuals forgoing substance use disorder treatment, this proposal could very literally translate into a death spiral for those with opioid use disorders."

In addition, Senator Van Hollen advocated for the opioid funding in the bipartisan 21st Century Cures Act, another bipartisan law that was signed on December 2016, which allocates $1 billion to states to meaningfully address this crisis. Sadly, Republican efforts to repeal the Affordable Care Act would be a huge setback on an issue that has gotten support from both sides of the aisle. Most recently, he wrote to President Trump strongly opposing repeal of the health reform law, specifically highlighting the $5.5 billion in funding that would be cut from states battling the epidemic.

Other senators signing the letter include Senators Patrick Leahy (D-Vt.), Cory Booker (D-N.J.), Sherrod Brown (D-Ohio), Tammy Baldwin (D-Wisc.), Jeanne Shaheen (D-N.H.), Kirsten Gillibrand (D-N.Y.), Tim Kaine (D-Va.), Richard Blumenthal (D-Conn.), Joe Manchin III (D-W.V.), Jack Reed (D-R.I.), Sheldon Whitehouse (D-R.I.), Al Franken (D-Minn.), Elizabeth Warren (D-Mass.), Dianne Feinstein (D-Calif.), Patty Murray (D-Wash.), Amy Klobuchar (D-Minn.), Maggie Hassan (D-N.H.), Mark Warner (D-Va.), and Bill Nelson (D-Fla.).

The full text of the letter is below:

Majority Leader McConnell:

We write to express significant concerns with the "American Health Care Act" and its impact on individuals and families who are struggling with opioid use, misuse, and use disorders. This bill, which purports to replace the Affordable Care Act (ACA), is rapidly progressing through the House of Representatives with the support of the President and will have a demonstrably negative effect on our country's continued battle against the opioid crisis.

Each day, 91 Americans die of an opioid overdose. Unfortunately, this trend is only on the rise as nineteen states, including Kentucky, saw a statistically significant increase in overdose deaths between 2014 and 2015. Synthetic opioids, including fentanyl (which is 50 to 100 times more potent than morphine), are quickly becoming a national threat, contributing to an increase in overdose deaths by nearly 80 percent between 2013 and 2014. In addition to hurting families and communities, the opioid epidemic profoundly impacts our economy, costing more than $75 billion per year.

Recognizing the importance of this public health epidemic, the Senate made essential strides in the 114th Congress to fight the opioid crisis. We passed legislation to authorize new mental health and substance use disorder programs, enhanced funding to states in the throes of the opioid epidemic, and worked with the previous Administration to increase access to medication-assisted treatment. It is incumbent upon us to not allow the new healthcare replacement proposal to detract from the progress we have made, or worse, exacerbate this public health and economic threat.

This is particularly salient with the House Republicans' desire to end Medicaid as we know it through the American Health Care Act. Medicaid, which was enhanced and expanded through passage of the ACA, is a lifeline to millions of Americans battling substance use disorders. It is the largest payer of mental health and substance use disorder care in the country, with 12 percent of adult Medicaid beneficiaries living with some form of a substance use disorder, including an estimated 76,000 Kentuckians. In fact, between 2014 and mid-2016, Kentucky's Medicaid expansion population increased its utilization of substance use disorder services by 740 percent. Medicaid also finances one-third of the medication-assisted treatment administered for opioid and other substance use disorders in the country. Many states have been fortunate to use provisions in the ACA to increase access to treatment for those with opioid use disorders. For example, Kentucky used Medicaid expansion to increase access to opioid use disorder treatments, and currently, Medicaid pays for 44 percent of the medication-assisted treatment provided in Kentucky.

People with opioid use disorders have benefited greatly from a provision in the ACA that requires Medicaid alternative benefit plans to include the ten essential health benefits, including mental health and substance use disorder services. However, the American Health Care Act would end this requirement for millions of enrollees, including those eligible under the Medicaid expansion. This comes in addition to ending the Medicaid expansion as we know it today. Repealing the essential health benefits requirement for Medicaid alternative benefit plans would abandon the 1.3 million Americans who access behavioral health care services through Medicaid expansion. Repeal of the Medicaid expansion would also cut $4.5 billion in funding for these services, interrupting treatment and inhibiting access for Americans trying to obtain the care they need and deserve.

Further, fundamentally changing Medicaid into a per capita cap system will result in irreparable cuts to the program. States will be left holding the bag, forced to raise taxes or cut services like mental health and substance use disorder treatment. Per capita caps are also fundamentally incapable of responding to new public health threats, like a spike in opioid-related overdoses or new blockbuster treatments or cures with exorbitant price tags. Indiana, for example, was able to help mitigate the impact of a 2015 HIV outbreak, caused by needle sharing between intravenous opioid users in Scott County, through enrolling Hoosiers into the state's expanded Medicaid program. Per capita caps, if they had been in place at the time, would have prevented the state from drawing down additional resources from the federal government to help address this outbreak and ensure individuals affected could access the critical care they needed.

In addition, the American Health Care Act loosens consumer protections and reduces the quality of coverage available in the individual market. The bill removes the requirement that insurers provide minimum levels of coverage for the cost of covered services, which will mean that consumers will have to pay more out-of-pocket for their health care needs. This, coupled with insufficient premium tax credits, the repeal of the cost-sharing subsidies, and high-risk pools, will substantially hinder access to care for those with mental health and substance use disorders. Given that lack of insurance coverage and an inability to afford care often result in individuals forgoing substance use disorder treatment, this proposal could very literally translate into a death spiral for those with opioid use disorders.

During his campaign, President Trump promised to help individuals struggling with addiction by "expanding access to treatment and prevention options." The American Health Care Act blatantly breaks this promise. Any healthcare legislation that we consider in the Senate must ensure that those living with opioid use disorders are getting affordable, comprehensive care to manage their disease. Anything less would not only be antithetical to the actions this body took in the 114th Congress to fight the opioid epidemic, but would also be a grave disservice to the individuals, families, and communities battling this scourge each day.

We urge you to not take up any legislation that will further harm Americans suffering from substance use disorders. We cannot turn our backs on them now.

Sincerely,