The devastating impacts of Kentucky’s opioid epidemic are well known and far-reaching. As a result of the Affordable Care Act (ACA), more Kentuckians struggling with addiction problems have been able to access much-needed treatment. However, the House GOP plan to repeal the ACA, the American Health Care Act (AHCA), would roll back opportunities for treatment — inevitably worsening the drug and overdose crisis in our state.
While the opioid addiction epidemic is a national problem, Kentucky has been one of the hardest hit states. In 2000, nine counties in the U.S. had drug overdose death rates of more than 20 per 100,000 people, and four were located in Kentucky. By 2014, 64 of Kentucky’s 120 counties had overdose death rates that high. And these rates have continued to rise. Kentucky has the third highest rate of death due to drug overdose, alongside Ohio.
Here’s what the ACA did to help our state’s drug problems:
- The number of Kentuckians with health insurance increased thanks to the ACA, with 440,000 Kentuckians gaining coverage through the state’s expansion of Medicaid alone. Consequently, the rate of uninsured in our state dropped dramatically.
- Addiction treatment was included as an essential health benefit. This means that expanded Medicaid and all individual and small group health insurance plans were required to cover treatment for opioid use disorders. Prior to the ACA many insurance plans did not cover substance use treatment. For instance, in 2012 326,000 Kentuckians were enrolled in individual-market or small-employer health insurance plans that were not required to cover these services and when they did cover treatment often included stricter limitations. Between 2014 and 2016, alcohol and drug use treatment utilization in Kentucky grew by more than 700 percent for those receiving insurance through the Medicaid expansion. In addition, more than 44 percent of prescriptions for the addiction treatment medication buprenorphine in Kentucky are currently paid for by Medicaid.
- Under the ACA, insurers have to cover behavioral health care, including drug treatment, to the same degree they cover other kinds of health care, which is called “parity.” As a result, the benefits for treating an opioid use disorder in particular have to be comparable to the coverage of other medical procedures. These services can’t have higher cost-sharing, more restrictive limitations or more limits on the number of services than similar coverage for physical health conditions.
Here’s how the AHCA would roll back access to drug treatment:
- Fewer Kentuckians would have health insurance. A big part of this is the effective end of the Medicaid expansion through the AHCA, but also due to the reduction in affordability in the private market that would occur due to lower subsidies for low-income people and insurance pools made up of sicker people, which will raise insurance costs. Nationally, the Congressional Budget Office expects 24 million people to lose coverage who would otherwise be covered by Medicaid, through work, or by purchasing insurance directly from an insurance company.
- The AHCA would remove substance abuse treatment as an essential benefit for Medicaid, making it optional for states as to whether Medicaid covers such services.
- The proposed per capita cap for Medicaid would gradually squeeze federal funding for the program overall, forcing the state to ration care among people and benefits and/or reduce payments to providers, all of which could reduce access to treatment. In addition, the formula won’t be responsive to spikes in costs — like we experienced with the opioid crisis — in the future.
The AHCA would inevitably worsen the severe addiction problems our state is already grappling with. Given that Kentucky’s drug problems are becoming even more challenging as overdose deaths related to the powerful opiates fentanyl and carfentanil are on the rise, we’d be likely left even worse off than before the ACA.
Updated March 15, 2017
