Carper: ACA Repeal Will Hurt States Fighting Opioid Crisis

As States Apply for $1 Billion in Grants Made Available by 21st Century Cures Act, ACA Repeal Would Pull $5.5 Billion Away from Needed Addiction Services

WILMINGTON, Del. – On Feb. 3, 2017, U.S. Senator Tom Carper (D-Del.) joined 22 of his colleagues in the Senate in a letter to President Donald Trump warning that repealing the Affordable Care Act (ACA) with no replacement would pull the rug out from under local communities working to combat the opioid epidemic and could endanger millions of Americans just as they are getting treatment. 

Repeal threatens to cut $5.5 billion from states battling opioid addiction. A recent report from Harvard Medical School and New York University details the devastating impact the repeal would have on those struggling with addiction. Nationwide, nearly 1.3 million Americans currently receiving treatment for substance abuse or mental health disorders would be kicked off of their coverage under repeal. And states would lose $5.5 billion in federal dollars each year that go toward treating these Americans through the Medicaid expansion or the marketplaces. 

Delaware, like many other states around the country, has not been immune to the heroin and opioid addiction crisis over the last several years. According to the Delaware Department of Health and Social Services (DHSS) in 2014, there were 189 overdose deaths in the state. In 2015 there were 228 people who died from addiction and about 125 suspected overdose deaths through July 2016. In 2015 Delaware public health data showed that there were just under 10,000 admissions for substance abuse disorders in public treatment facilities in the state with about 3 out of 10 people indicating heroin as their primary drug of abuse at admission. In 2014 the Centers for Disease Control report that Delaware was ranked ninth in the nation for drug poisoning death rates overall. 

“The consequences of repealing the Affordable Care Act are dire for all Americans, but they are especially calamitous for Americans living with a mental illness, a substance use disorder, or both,” said the Senators in the letter. “Repealing this law will cut billions of dollars in funding, kick tens of millions of Americans off of their health insurance, and saddle providers with hundreds of millions of dollars more in uncompensated care.” 

In December 2016, President Obama signed into law the bipartisan 21st Century Cures Act – legislation that will provide $1 billion in federal grant funding over the next two years to states to fight the opioid epidemic. But now, Congress is working to repeal the health law and pull addiction services – and funding for treatment – out from under millions of Americans. In the letter, the Senators note that at the same time states are competing for the grants made available through Cures, ACA repeal stands to take away $5.5 billion in just one year from addiction and mental health treatment services.

The letter was also signed by U.S. Senators Sherrod Brown (D-OH), Tammy Baldwin (D-WI), Jeanne Shaheen (D-NH), Dianne Feinstein (D-CA), Patty Murray (D-WA), Jack Reed (D-RI), Debbie Stabenow (D-MI), Benjamin L. Cardin (D-MD), Amy Klobuchar (D-MN), Sheldon Whitehouse (D-RI), Kirsten Gillibrand (D-NY), Al Franken (D-MN), Richard Blumenthal (D-CT), Brian Schatz (D-HI), Christopher Murphy (D-CT), Tim Kaine (D-VA), Elizabeth Warren (D-MA), Edward J. Markey (D-MA), Cory Booker (D-NJ), Gary C. Peters (D-MI), Chris Van Hollen (D-MD), and Margaret Wood Hassan (D-NH).

Full text of the letter is below.                                                       

February 3, 2017 

The Honorable Donald J. Trump
President of the United States of America
The White House
1600 Pennsylvania Ave, NW
Washington, DC 20500 

Dear President Trump:

We write with serious concern that your work advancing efforts to repeal the Affordable Care Act (ACA) with no clear plan for replacement will substantially worsen the opioid epidemic, endangering the lives of millions of Americans with opioid use disorders. Last year, Congress took important steps to address this national public health crisis, enacting not one, but two bipartisan laws to address the opioid epidemic and reform the way our health system treats mental health and substance use disorders. However, repealing the ACA with no clear plan for a replacement, you risk both undermining all of that progress and setting our communities fighting the opioid epidemic farther back with the stroke of a pen.

The Comprehensive Addiction and Recovery Act (P.L.114-198) authorized programs to improve access to substance use disorder prevention, treatment, and recovery services. It promoted the use of best practices when prescribing opioid pain-killers, strengthening state prescription drug monitoring programs, and expanding access to the life-saving drug naloxone. Importantly, the legislation also allowed nurse practitioners and physician assistants to begin prescribing the drug buprenorphine to treat addiction. 

The 21st Century Cures Act (P.L.114-255) also included critical mental health and substance use disorder reforms, establishing an Assistant Secretary for Mental Health and Substance Use, strengthening enforcement of mental health parity laws, promoting the integration of physical and mental health care, and promoting an expanded mental health workforce.

Most importantly, the 21st Century Cures Act dedicated $1 billion in new funding over two years to assist states in combatting the opioid epidemic. Already, states are actively working on applying for this new grant funding, which will be essential to helping states provide prevention, treatment, and recovery services to patients, especially those who have trouble affording them and those living in rural areas and on tribal lands.

These bipartisan advances and accomplishments will be fundamentally undermined by repeal of the Affordable Care Act, which critically strengthened the health care foundation on which these recent measures are built. What is more, your ACA repeal agenda stands in direct conflict with your public commitment to end the opioid epidemic in America.  In a recent article, two former Assistant Secretaries for Planning and Evaluation noted that, “repealing the mental health and substance use disorder coverage provisions of the ACA would withdraw at least $5.5 billion annually from the treatment of low income people with mental and substance use disorders.” A funding cut that is more than ten times greater than the funding increase included in the 21st Century Cures Act.

To make matters worse, repealing the ACA would mean that more than 1.2 million people with serious mental illness and 2.2 million people with substance use disorders will lose some or all of their coverage. In the states with the highest opioid overdose death rates, the uninsured rate would triple. Repeal would also hurt providers by increasing uncompensated care. Further, since passage of the ACA, the number of hospitalizations for substance use or mental illness in which the patient was uninsured dropped from 22 percent to 14 percent. We would be likely to see these numbers skyrocket after ripping coverage away from millions of Americans, forcing them back into the emergency room when they have nowhere else to go. 

Repealing the ACA will undo critical consumer protections for tens of millions of Americans and rob more than 9 million families of the tax assistance provided under the law to make their coverage affordable. Furthermore, it will roll back the same mental health and substance use disorder parity protections that were strengthened under the 21st Century Cures Act, and eliminate the mandatory coverage of treatment for these conditions as an essential health benefit. In addition, repealing the ACA will make it even more difficult to diagnose mental illness and substance use disorders by removing the requirement that preventive services like depression and addiction screenings are provided to patients for free at the point of service.

The ACA’s investments in substance use disorders, while critical to addressing the immediate needs of the opioid epidemic, are essential to continue fighting all types of addiction. In addition to hurting millions of Americans struggling with addiction, cutting funding for substance use disorder prevention, treatment, and recovery services could significantly increase costs to our health care system and taxpayers in the long-run. According to the National Institute on Drug Abuse, illicit drugs such as cocaine and methamphetamines already cost our health care system $11 billion annually.  

The consequences of repealing the Affordable Care Act are dire for all Americans, but they are especially calamitous for Americans living with a mental illness, a substance use disorder, or both. Repealing this law will cut billions of dollars in funding, kick tens of millions of Americans off of their health insurance, and saddle providers with hundreds of millions of dollars more in uncompensated care. We strongly urge you to uphold your pledge to end the opioid epidemic in America by working to strengthen substance abuse treatment protections and taking no further action to repeal the Affordable Care Act without guaranteeing that such actions and policies will not harm Americans with mental illnesses or substance use disorders.