Combating opioid epidemic, repealing ObamaCare will hurt the cause

The same Congress that last year banded together to pass a comprehensive bill aimed at tackling the virulent opioid epidemic sweeping the nation came close to dismantle underlying insurance protections that provide a valuable tool toward reducing staggering addictions statistics.

Elections have consequences, and one of the major impacts from the continued Republican hold on the U.S. Congress — combined with the ascension of President Donald Trump to the White House and Rep. Tom Price (R-Ga.) to head the Department of Health and Human Services — is the desire to gut the Affordable Care Act (ACA), otherwise known as ObamaCare.

{mosads}Whether you oppose or support the mandatory healthcare coverage for all Americans, ACA includes a requirement that insurance plans provide a base package of essential health benefits. These benefits include mental health and substance use disorder services, including counseling and psychotherapy.

While on the campaign trail, Trump did not have a well-articulated plan for a replacement healthcare plan or how to adequately address the opioid addiction. The only inkling of a plan he presented was to build a wall between the U.S. and Mexico to staunch the perceived flow of heroin from entering the country. With all due respect to the president, it’s not that easy. According to the National Institute on Drug Abuse, nearly two million Americans are addicted to prescription pain relievers, often the gateway to heroin use; four out of five new heroin users started off misusing prescription pain drugs. This is not a criminal justice problem. It’s not an immigration problem. Opioid addiction is a public health crisis that deserves a public health response.

But the drive to dismantle the previous president’s legacy seems to override logic.

While efforts on in Congress to repeal and replace ObamaCare failed last week, the effort will not go away. Trump has already taken initial steps to rein in the ACA, a move that runs contrary to his stated desire to help those suffering from opioid addiction. Full repeal of ObamaCare would gut major benefits and protections for the estimated 60 million Americans who suffer from mental illness and substance abuse disorders, which according to the latest Surgeon General’s report, often go hand-in-hand.

Thirty-one states and the District of Columbia expanded eligibility for the state-federal low-income health insurance program under ObamaCare, giving previously uncovered Americans access to substance abuse services. The law requires states that expanded Medicaid programs to include substance abuse treatment coverage, through ACA allows the states to choose types of treatments and medications covered. If Congress dismantles the law, what happens to the people who desperately need these critical services? We should not be eliminating access to treatment at a time when opioid abuse statistics are staggering.

According to the Centers for Disease Control and Prevention (CDC), overdose deaths have quadrupled since 2000. In North Dakota, the number of death overdose cases increased 125 percent between 2013 and 2014 but Rep. Kevin Cramer (R-N.D.) and delegation mate Sen. John Hoeven (R-N.D.) have both vowed to overturn ACA. In New Hampshire, a key battleground state Trump won in the primaries and barely lost to Secretary Hillary Clinton in the general election, the overdose death rate rose by nearly 75 percent in the same time period. Voting for repeal will hamstring not just these states but myriad others were the epidemic rages.

Some Members of Congress seem eager to take down the law not because it isn’t working, but as a parting shot at the last president. Those who represent states and districts suffering from opioid addiction ought to take a second look at the law’s benefits to their constituents. As opioid addiction becomes more deeply rooted, we need more paths toward recovery, not fewer.

My hope, as a physician specializing in pain who has witnessed the path to addiction all too often, is that the Congress that overwhelmingly passed the Comprehensive Addiction and Recovery Act will also, as they look ahead, work to protect those elements of ACA that help ensure continued access to the counseling, treatment and drugs necessary to address this disease. Walls and cops are not the prescribed solution.

Mehul Desai MD, president of the International Spine, Pain & Performance Center, is board certified in Pain Medicine and Physical Medicine & Rehabilitation. He is the Legislative Fellow of the North American Neuromodulation Society.

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