Look at a map of states president-elect Donald Trump won in November alongside a map of states with the highest rates of opioid prescriptions, and you'll see they mostly overlap. Look more closely at the data, as one Penn State professor recently did, and you'll find that Trump outperformed his Republican predecessor Mitt Romney the most in counties where opiate and suicide mortality rates are highest. It's little wonder, then, that mental health and substance abuse issues have become a key talking point for Trump, who has promised to crack down on drug cartels and called America's mass shootings an issue of mental health--not guns. He's not the only Republican to adopt behavioral health as a priority. House Speaker Paul Ryan pushed for mental health legislation in the wake of the San Bernardino shooting.
There are plenty of reasons why the Obamacare repeal bill that House Republicans passed Thursday afternoon is so controversial. It slashes funding for Medicaid, threatens to raise health insurance premiums for older Americans, and allows states to roll back protections for people with preexisting medical conditions. But there's another, less publicized, way in which the GOP's American Health Care Act could disrupt health care throughout the country. In the midst of the most devastating drug epidemic in US history, the legislation could disrupt addiction coverage for millions of Americans. And thanks to a provision added to the bill last week, insurance companies in some states might no longer include mental health and substance abuse coverage in their health plans.
A vial of Naloxone and syringe are pictured at a Naloxone training class for adults and children to learn how to save lives by injecting Naloxone into people suffering opioid overdoses at the Hillview Community Center in Louisville, Kentucky, on Nov. 21, 2015. In an opioid epidemic that is killing tens of thousands of people nationwide, finding and paying for addiction treatment remains a challenge for low-income Americans, particularly in the South and parts of the West. But Medicaid coverage of the most widely used opioid addiction medication, buprenorphine, varies widely among states. Many doctors don't want to treat Medicaid patients for addiction. And red tape can make it difficult for many Medicaid recipients with addictions to get effective treatment.
During his campaign, President Donald Trump said his supporters were "always" bringing up one issue: the opioid epidemic. "We're going to take all of these kids--and people, not just kids--that are totally addicted and they can't break it," he promised at a Columbus, Ohio town hall meeting last August. "We're going to work with them, we're going to spend the money, we're gonna get that habit broken." Yet in the midst of the largest drug epidemic in the nation's history, the Republican plan to replace Obamacare threatens to cut insurance coverage for mental health and addiction treatment for millions of Americans. The effect, public health advocates worry, would be to further decrease access to substance abuse treatment at a time when drug overdoses are claiming more 50,000 American lives per year--more than car accidents or gun violence.
Under the Republican health care proposal the House passed last week, insurance plans would not have to cover maternal and newborn care. Critics of the Republican health care plan the House passed last week mostly have focused on how it might harm Americans with pre-existing health conditions and poor and disabled people who rely on Medicaid -- two vulnerable, but defined, populations. But another change might have more far-reaching effects: eliminating the Affordable Care Act's "essential health benefits," or EHBs. That shift could affect almost everybody, including the 156 million Americans who receive health coverage through their employers. Under the ACA, health plans sold to individuals and small groups (employers with 50 or fewer employees) must include 10 essential benefits: emergency services, habilitative and rehabilitative services, inpatient care, outpatient care, maternity and newborn care, mental health and addiction treatment, lab tests, preventive care, prescriptions, and pediatric services, including oral and vision care.