Eliminating fraud is key to adequate funding for opioid treatment

Over the next several weeks and potentially even months, Congress will struggle with legislation to repeal and replace the Affordable Care Act (ACA), also known as ObamaCare. One of the key issues that Capitol Hill will grapple with during the healthcare debate is the fight over funding for drug treatment, particularly opioid addiction.

While this problem might not be a burning matter for most folks living inside the Beltway, it is a serious issue across the nation and at epidemic levels in some of the hardest hit regions.

{mosads}In my home state of Michigan, nearly 2000 people died from overdoses in 2015 — more than double the number of people killed in car accidents. Michigan ranks 10th nationally in per capita prescription rates of opioid pain relievers and 15th in the nation for all overdose deaths.

As things currently stand, both the House and Senate healthcare reform bills undermine treatment for substance abuse. Both pieces of legislation allow states to waive some of the essential health benefits mandated by the ACA. One of those essential benefits is mental health and substance abuse disorder treatment. Healthcare analysts believe that substance-abuse treatment is one of the benefits states are most likely to cut in an effort to bring down premiums.

A 2017 HHS report found that approximately 34 percent of individual market insurance plans prior to passage of the ACA failed to cover substance abuse treatment.  Currently, 1.84 million people in the U.S. receive treatment for substance abuse disorders or mental illness through Medicaid expansion or the ACA’s individual insurance marketplace.

States rely on the ACA’s Medicaid expansion for substance abuse treatment. The Associated Press found that the expansion accounted for 56 percent of total Medicaid spending on substance abuse treatment in Michigan — among the most of any state. In West Virginia, the state with the highest drug-overdose death rate in the U.S., and Ohio, which is third, Medicaid paid for 47 percent and 43 percent of treatment costs. These percentages are similarly high in other states affected by the opioid crisis.

Two Republican Senators, Ohio’s Rob Portman and Shelley Moore Capito of West Virginia, requested $45 billion over 10 years after an earlier bill allotted only two billion.  As of today, the Senate bill granted that request. 

Another concern that must be addressed in any ACA reform, is the waste, fraud and abuse of government funds associated with the treatment of opioid addiction. Due to increased dependency issues and the benefits provided by the ACA that help patients secure access to treatment, levels of insurance and Medicaid fraud by so-called healthcare providers have risen substantially.

ProPublica published an expose on this issue, and pointed to one company, Psychiatric Solutions, Inc. (PSI), as an example of one bad actor that put profit ahead of care and was surely a questionable recipient of taxpayer funds. The report found multiple incidents where efforts to maximize shareholder returns led to patients being victimized by poorly trained staff. PSI was eventually purchased by another publicly traded corporation, Universal Health Services (UHS), which also relies on taxpayer-funded programs for its profits, primarily Medicare and Medicaid.

BuzzFeed followed up on the ProPublica investigation, and found that little had changed –profits appeared to outweigh care at UHS. The ensuing outcry led to investigations by the FBI and Department of Defense.  Notably, when UHS purchased PSI, the PSI leadership team moved to another company — Acadia — that also offers treatment for opioid addiction. Sen. Charles Grassley has been asking HHS for answers about UHS.  As Chairman of the House Energy and Commerce Committee’s Oversight Subcommittee, I would have immediately launched an investigation into Acadia, or at a minimum, would have encouraged the Centers for Medicare and Medicaid Services to review the Medicare and Medicaid charges made by UHS and Acadia.

As a former Michigan State Trooper, I realize that we must address opioid addiction not as just a crime, but also as a healthcare crisis. My greatest fear is that if Congress fails to provide adequate funding and fails to combat Medicaid fraud associated with treatment, the law enforcement community will be left to pick up the pieces.

Law enforcement arrests will increase the prison population creating more broken families and fail to halt the very serious epidemic plaguing our nation. I encourage my former colleagues on Capitol Hill to do the right thing. Provide the necessary funding to combat opioid addiction.

Bart Stupak, was nine-term Congressman and Michigan Democrat. He is the author of a new book called: “For All Americans” a behind-the-scenes look at the inner workings of Congress during the Passage of the Affordable Care Act.

The views expressed by contributors are their own and not the views of The Hill.