GOP health plan failure good for addiction help
Residents touched by addiction and local health officials who oversee addiction recovery treatment told the Herald-Standard they are wary of any legislation that would reduce coverage for those in addiction or mental health treatment.
That included the American Health Care Act of 2017 (AHCA), unveiled as a replacement for the Patient Protection and Affordable Care Act, signed into law in 2010 by former President Barack Obama. Republicans pulled the AHCA from the House floor Friday, effectively killing the bill amid expectations that a floor vote would fail.
Some officials and residents cited Fayette, Greene, Washington and Westmoreland counties’ comparatively high reliance on Medicaid and rampant opioid abuse as a dangerous combination of circumstances if that coverage is rolled back, warning that the AHCA would have a devastating local impact.
“I think it’s great,” said Christeen Myers of North Belle Vernon about the AHCA’s failure to pass Friday. Myers’ son struggled with addiction, and she thought a repeal of the Affordable Care Act would be “awful” for drug addiction treatment access and quality.
The American Health Care Act would have removed an Affordable Care Act requirement that Medicaid cover essential health benefits such as substance use disorder and behavioral health treatment in states such as Pennsylvania that expanded it, allowing those states to decide whether to include those benefits in Medicaid plans starting in 2020.
A concession offered to conservative Republicans Thursday to garner support for the bill included eliminating essential health benefits for private insurance as well, according to the Associated Press.
That elimination would have threatened substance use disorder and mental health coverage, since 34 percent of individual market plans did not offer coverage for substance abuse services and 18 percent did not offer coverage for mental health services prior the ACA, according to the Department of Health and Human Services.
“It really guts it,” Antoinette Kraus, executive director of the Pennsylvania Health Access Network, said of the AHCA’s potential impact on health care coverage for those fighting substance use disorders prior to the bill’s failure Friday.
The AHCA would end the enhanced federal Medicaid funding for new enrollees starting in 2020. Those already in the program would be permitted to stay as long as they remain continuously insured.
The House proposal would have resulted in 24 million people losing coverage by 2026, reducing federal spending on Medicaid by a cumulative $880 billion by that year, according to the nonpartisan Congressional Budget Office. It called for removal of a requirement for individual marketplace insurance to cover specified percentages of expected medical costs. That means individuals’ share of insurance costs, including deductibles, would have tended to be higher under the AHCA than those anticipated under the ACA, according to an analysis by the CBO.
“I thought, ‘Here it goes … all these people are going to suffer,'” Myers said.
A provision added to the AHCA would have also enabled states to receive a certain portion of federal Medicaid funding in a block grant, which experts said would have likely resulted in cut funding for states and too much of a burden on states to fill the funding gap.
“Long-term, that would not be sustainable,” Paul Bacharach, president and CEO of Gateway Rehab, said of the block grant system, which he predicted would result in cuts in medical treatment options due to a state inability to meet patients’ Medicaid needs.
Local proponents of Medicaid expansion think maintaining treatment availability is especially important considering the area’s significant drug problem.
Greene County had the fifth-highest rate in the state of drug-related overdose deaths per 100,000 people in 2015, according to the Drug Enforcement Administration Philadelphia Field Division Intelligence Program. Westmoreland had the seventh-highest rate, Washington the ninth-highest and Fayette the 16th-highest, while Washington County also suffered a 103 percent increase in drug-related overdose deaths from 2014 to 2015, the fifth-largest jump in the state.
Eight years after his son died of an overdose at age 26, Bacharach thinks drug addiction treatment is worth its cost.
“Every dollar spent on addiction treatment saves seven dollars somewhere else, whether it’s fewer incarcerations, patients are working, etc.,” Bacharach said.
“What I would want is nothing to be taken away from people that would limit them to be able to access treatment,” said Jana Kyle, executive director of the Fayette County Drug and Alcohol Commission.
Myers’ son, Gerald Szakal, is serving two consecutive life sentences at the state prison in Greene County, convicted of two counts of second-degree murder in the 2008 shooting deaths of retired Carroll Township police chief Howard Springer and his wife, Nancy.
Myers said that a desire to obtain money for heroin led Szakal to several thefts and eventually those murders, and she added that the area could expect an uptick in drug-related crimes if there is an increase in the number of local addicts who cannot access the care they need.
The AHCA would have led to such an increase, Myers predicted, and she’s relieved the bill failed.
“It came so close that I thought everything was going to blow up,” Myers said. “It came so close to a great loss.”