National Press Club

ACA's Medicaid expansion has helped addicted find treatment but system still “overwhelmed”

September 26, 2017 | By Jean Gossman |

Kenneth Rogers, Psy.D., a licensed psychologist with Kaiser Permanente, speaks at a Sept. 25, 2017 NPC Newsmaker event about proposed cuts in Medicaid.

Kenneth Rogers, Psy.D., a licensed psychologist with Kaiser Permanente, speaks at a Sept. 25, 2017 NPC Newsmaker event about proposed cuts in Medicaid.

Photo/Image: Noel St. John

Panelists at a National Press Club Headliners Newsmaker event on Monday voiced alarm that proposed Medicaid cuts in the Senate Graham-Cassidy healthcare bill would cripple strapped states’ effort at addressing the opioid crisis and compound difficulty in enforcing parity between mental health and physical health care.

“The debate this week on the Graham-Cassidy bill is front and center on the opioid issue,” said Rep. Tim Ryan, (D-Ohio), co-chair of the House Addiction Treatment and Recovery Caucus. “There is no way [lawmakers] can vote and support the Graham-Cassidy bill” if they support treatment programs in their communities. Republicans in the Senate opted Tuesday not to vote on the bill in the face of likely “no” votes from some GOP senators.

In his own hard-hit state, Ryan said between now and 2026 under Graham-Cassidy “200,000 people would be thrown off [treatment] and be told to pull themselves up by their bootstraps.”

Medicaid is the country's largest payer for addiction services and covers a significant portion of opioid addiction medication. Without the Medicaid expansion program enacted under the Affordable Care Act, treatment providers like Cuyler Costanzo, a clinical coordinator with Oriana House, an addiction and recovery center in Akron, Ohio, “wouldn’t be able to help” patients who have “pretty much lost everything by the time they get to us.”

According to Costanzo, the U.S. in 2015 experienced 52,000 opioid-related overdoses leading to death. In 2016 there were 64,000 -– a 23 percent increase. He added that recently the Cincinnati area saw 200 opiate uses resulting in arrest in one week, along with 18 overdose deaths. In the same week, 15 babies were born with what Costanzo called “opiate-related medical concerns.”

Although President Donald Trump claimed last month that opioid addiction is “a national emergency,” promising “to spend a lot of time, a lot of effort and a lot of money,” and campaigned on this issue, some view Trump’s statements as mere lip service.

“That’s just what he said. Nothing has happened since then,” said Ryan. “Really, all he has to do is tell [HHS Secretary Tom] Price to implement this as an emergency.”

Ryan, co-chair of the Military Mental Health Caucus reported “a very high level of frustration” among his Capitol Hill colleagues in the face of “an epidemic that needs to be dealt with in a comprehensive way –- from law enforcement, to prevention, to treatment, to overdose issues.”

The Trump administration's FY 2018 budget proposes substantial cuts to the Administration for Children and Families, the Substance Abuse and Mental Health Services Administration, and the Temporary Assistance for Needy Families program. Ryan said he would like to see more research and attention to alternative treatments for chronic pain as well as addiction treatment research. He also called school social-emotional learning programs “a great investment for the long term” to help addicted parents’ children.

Infants and children are "often the collateral damage" of substance abuse, said Jackie Schalit, a marriage and family therapist at University of California San Francisco Benioff Children's Hospital in Oakland. "Trauma is stacked up against" children of addicted parents. Many opioid-addicted parents are incarcerated, and many also give birth to addicted babies.

Persons who become addicted to opioid painkilling drugs often have "serious underlying mental health problems," noted Kenneth Rogers, Psy.D., a licensed psychologist with Kaiser Permanente in Northern California. Their addiction "comes at a cost" -- missed family and social time, and missed work. Rogers cited results from a new study by Princeton economist Alan Krueger that found between 1999 and 2015, roughly 20 percent of the drop in men's workforce participation and 25 percent of women's was due to painkiller drug use.

Medicaid expansion “has really helped our clients get the treatment they need, but even with it we’re overwhelmed,” Costanzo said. Previously, opioid-addicted patients more often than not had to rely on the emergency room for treatment, if they were treated at all. Even with expansion, “we’re overwhelmed.” Without expanded Medicaid access, Costanzo added, “a lot of good Americans are going to continue suffer and they’re going to die.”