Washington, D.C. — A new column co-authored by health economists at the Center for American Progress and Harvard University finds that the Senate health care repeal bill’s reported $45 billion fund for opioid use disorder (OUD) treatment provides scant resources toward the cost of OUD, including in states like West Virginia and Ohio, which have among the highest rates of opioid overdose deaths in the country.
The column includes state-by-state estimates of the cost of coverage for people treated for OUD compared to the funding available in the Senate bill. For example, the Senate bill’s opioid fund could offer West Virginia $61 million and Ohio $272 million in 2026. As a result, West Virginia’s share of the Senate opioid fund in 2026 would be less than one-fifth of the total cost of comprehensive coverage for people treated for OUD.
Coupled with the steep cuts to the Medicaid program and undoing of the Medicaid expansion, these cuts could gravely undermine efforts to curb the nationwide opioid epidemic. CAP estimates that by 2026 the cost of comprehensive coverage for all people treated for OUD in West Virginia and Ohio—two states currently mired in the epidemic—could reach $351 million and $2.2 billion, respectively.
Growth of treatment would generate staggering costs even in smaller states like Maine, where the report estimates the total cost of coverage for people with OUD would be $170 million in 2026 compared with $21 million from the Senate fund.
“The Senate bill’s $45 billion fund is merely a cover-up for the fact that the AHCA would strip millions of Americans of coverage while at the same time reducing the generosity of health insurance benefits,” said Emily Gee, health economist at CAP.
The $45 billion opioid fund included in that bill would not come close to mitigating harm from other parts of bill: Even if the entirety of the fund were available to cover low-income individuals being treated for OUD, $45 billion would provide only half of the $91 billion in federal funding that would be available under the ACA for health coverage alone. CAP estimates that the total cost of coverage for all people receiving OUD treatment could reach $220 billion over the next decade.
The American Health Care Act (AHCA) would essentially end the enhanced federal funding available for the Affordable Care Act’s (ACA) Medicaid expansion, which currently covers more than 11 million low-income adults, including 99,000 with OUD. Even if the Senate chooses to delay the repeal of Medicaid expansion by a few years, by 2026 the effect would be practically the same.
“Low income people with substance use disorder need treatment for those illnesses, but their health care needs extend well beyond those specialty services. Therefore, targeted grant programs will not substitute for broad-based insurance coverage,” said Richard G. Frank, Margaret T. Morris professor of health economics in the Department of Health Care Policy at Harvard Medical School. “Closing the treatment gap for a rapidly growing and evolving epidemic involves more than that, considering what we spent on substance use disorder care in 2016.”
Just like the House bill, the Senate version would cap the federal spending on most Medicaid enrollees, forcing states to expend more of their own budgets or reduce benefits. And just like the House bill, the Senate version could also make it difficult for people with private coverage to obtain treatment for OUD by allowing state waivers of essential health benefits, including substance use disorder treatment. Prior to the ACA, only 45 percent of individual market plans covered substance use disorder treatment.
CAP’s estimates of the total cost of coverage for people treated for OUD do not include the cost of health care for people who do not undergo treatment. It also does not include nonhealth-care costs of the crisis, such as prevention efforts and public safety—all of which contribute to rising costs.
Click here to read “Senate’s Opioid Fund Cannot Substitute for Health Coverage,” by Emily Gee and Richard Frank.
For more information or to speak with an expert, contact Devon Kearns at [email protected] or 202.741.6290.