In 2015, opioid-involved overdoses claimed more than 33,000 lives—a fourfold increase from 1999. Opioid overdoses caused nearly as many deaths in the United States as traffic accidents and twice as many as homicides. The toll of the epidemic is tremendous for those who struggle with addiction, as well as families, communities, and the economy. But while some Republican officials have promised to address addiction and support at-risk populations—President-elect Donald J. Trump pledged in October to provide every individual with addiction “access to the care and the help that he or she needs”—the House Republican agenda will hardly abate the opioid crisis. Instead, it is poised to do immense damage. Indeed, new analysis shows that repeal of the Affordable Care Act alone would strip 222,000 people with an opioid addiction of some or all of their health insurance coverage—and that is not the only way that House Republicans could do damage.
Who is at risk?
The opioid epidemic touches every racial group. However, fatal overdose rates among whites and Native Americans are more than double or triple those of blacks and Hispanics and more than 10 times higher than those of Asian Americans. Importantly, it is in part because the face of the crisis has been primarily white—unlike, for example, the crack-cocaine epidemic of the 1980s, which mostly affected black people—that it has garnered widespread attention and has been treated as a public health issue rather than a criminal one.
While the epidemic knows no geographic boundaries, opioid addiction has especially wreaked havoc on rural areas. In the early 2000s, overdoses of opioid painkillers in nonmetropolitan, noncore counties increased at rates more than seven times those of large, central metro counties. States with the highest rates of opioid overdose deaths—Kentucky, Ohio, New Hampshire, and West Virginia—are home to sizable rural populations. Rural areas have been hit hard by structural economic shifts, and research has posited that resultant high unemployment rates, lack of upward mobility, and material hardship are linked to increased nonmedical prescription opioid misuse.
Even though public health officials have deemed the opioid epidemic the worst drug crisis in U.S. history, efforts to mitigate its effects remain woefully underfunded. As a result, addiction services have not been able to meet the increased demand driven by the opioid epidemic, which has forced many individuals seeking to overcome addiction to forgo treatment altogether. Indeed, more than 80 percent of those who need treatment are unable to access it, and more than 30 million people live in counties—largely rural counties—without a single licensed provider of medication-assisted treatment. In the absence of adequate and appropriate treatment services, recovery from opioid addiction may be insurmountable.
Collateral damage
The impact of the opioid epidemic stretches far beyond those who struggle with addiction themselves, with dire consequences for families, communities, and the economy. It has driven a crisis in state foster care systems, which have become increasingly overburdened as a result. In Georgia, where 4 out of 10 children enter the foster care system in part because of their parents’ substance abuse, the state has begun to work with local churches to help support foster parents. And in Ohio, whose foster care system is also stretched thin, child welfare officials have struggled to place children with extended relatives because many of them are also addicted to opioids.
Beyond family dissolution, opioid addiction can lead to interaction with the criminal justice system and job loss, both of which threaten family stability and can plunge a family closer to the brink of poverty or deeper into it. The economy also suffers: One study estimates that opioid addiction costs the United States an estimated $78.5 billion annually.
House Republicans poised to do more harm than good
While House Republican leaders have paid lip service to the populations that have been hit hardest by opioid addiction, many have already demonstrated a lack of commitment to them. Last year, Congress passed a bill—the Comprehensive Addiction and Recovery Act—that authorized funds for opioid treatment. However, the law supplies a mere fraction of the $920 million proposed by Democrats; in addition, this money needs to be reauthorized each year, which means it is not guaranteed for 2018 and beyond.
But congressional Republicans are poised to do significantly more damage than that. The repeal of the Affordable Care Act, or ACA—which has long been a Republican objective—would cause 222,000 individuals who struggle with opioid addiction to lose some or all of their insurance coverage, which many people need in order to afford substance abuse treatment. If the ACA is repealed, all individual market enrollees who seek addiction treatment—not just those who become uninsured—stand to lose. Prior to the health care law’s passage, individual market insurers did not have to offer addiction treatment programs, and an estimated one-third of people who bought insurance on the individual market lacked coverage for substance abuse treatment as a result. However, under the ACA, substance abuse services—such as counseling, residential care, and medication—became an essential health benefit for plans sold in the individual market. All told, repeal threatens to siphon off at least $5.5 billion per year from treatment for low-income people with opioid addiction and mental health disorders.
In addition to the impact in the private market, millions of low-income Medicaid beneficiaries would lose access to all health care coverage—not just substance abuse treatment—if Congress rolls back expansion. Some states will be hit particularly hard. In Alaska and West Virginia, for example, Medicaid pays for between 35 percent and 45 percent of medication-assisted treatment, a proven method to combat addiction—but these states, among others, would likely be unable to foot the bill if expansion is dismantled. Finally, to add insult to injury, the plan to convert Medicaid into a block grant to the states—also a cornerstone of the Republican health care agenda—would result in sharp cuts to the program and millions more losing needed coverage.
House Republicans also intend to slash or even eliminate the Social Services Block Grant, or SSBG, which would have doubly harmful implications for those affected by the opioid crisis. The SSBG not only offers essential funds for states to provide substance abuse and other family support services to residents, it also helps fill in critical financial gaps for overburdened state foster care systems. With addiction services and foster care systems so underfunded, states—and the residents who rely on these services—cannot afford to see the SSBG cut.
House majority leaders have professed support for the communities that have been torn apart by the opioid epidemic, but the policy proposals they have put forth say otherwise. Unless they reverse course, the opioid crisis—and its consequences for those who struggle with addiction, as well as families, communities, and the economy—will only escalate.
Eliza Schultz is the Research Assistant and Katherine Gallagher Robbins is the Director of Family Policy for the Poverty to Prosperity Program at the Center for American Progress.