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ACA repeal could be detrimental to fight against opioid epidemic in WV


The Register-Herald

BECKLEY, W.Va. — Progress made in the battle against the opioid epidemic in West Virginia be dealt a devastating blow if the Affordable Care Act is repealed.

A new study shows if the ACA is repealed, more than 214,000 West Virginians suffering from addiction or mental illness will lose access to health care services.

The data analysis, conducted by Harvard Medical School and New York University, shows that West Virginia — the state with the highest drug overdose death rate in the nation — stands to lose the most.

Recovery Point West Virginia, which operates four long-term, residential addiction recovery centers for both men and women in three counties, is currently providing treatment services to 250 individuals.

“Currently, 98 percent of Recovery Point clients are enrolled in Medicaid through the ACA Expansion and have access to essential behavioral health and physical health services in our community,” said J. Matt Boggs, executive director of Recovery Point West Virginia.

“For individuals suffering from Substance Use Disorders, stopping the use of addictive substances is only the beginning,” Boggs said. “Each person requires a comprehensive recovery plan which includes tending to the underlying behavioral and physical ailments often neglected.”

Mental illness and Substance Use Disorder are oftentimes co-occurring. In West Virginia, nearly 205,000 residents who suffer from both are at risk of losing coverage.

Boggs said repealing the ACA without a proper replacement plan would leave West Virginia and its addicted population without desperately needed care.

According to the New York Times, President-elect Donald Trump demanded Tuesday the law be repealed immediately and a replacement be implemented shortly thereafter.

Sen. Joe Manchin has been critical of Republicans’ rush to repeal without a plan for replacement. He shared his concerns Wednesday in a release that the repeal could cripple the fight against the opioid epidemic.

“In West Virginia, half of the people in treatment would lose their coverage that was made possible through the Affordable Care Act,” Manchin said. “With our state leading the nation in drug overdose deaths, West Virginians cannot afford to have this critical funding ripped from them without a replacement ready.”

Business Insider reports a bill in the Senate to repeal significant parts of the ACA through the budget reconciliation process has a Jan. 27 deadline for committees to produce a repeal bill; however, Republican leaders have also discussed delaying such a bill until a full replacement plan can be created.

Harvard Medical School Health Economics Professor Richard Frank and New York University Dean Sherry Glied wrote in an op-ed, “The impact of repealing ACA provisions related to mental and substance use disorders would have particularly adverse effects on states that have experienced some of the most tragic increases in opioid related deaths.”

They continued, “Many of these states have seen their adult uninsured rates drop by more than 5 percentage points since 2014 and have been able to address opioid overdose problem with expanded services and funding under Medicaid expansion.”

The Department of Health and Human Services said after lawmakers passed Medicaid expansion in the Mountain State, the share of hospitalizations for substance use or mental health disorders in which the patient was uninsured fell from 23 percent at the end of 2013 to 5 percent at the end of 2014.

West Virginia also relies on Medicaid to pay for 45 percent of evidence-based Medication Assisted Treatment using buprenorphine, a medication used to treat opioid addiction.

Louise Reese, Chief Executive Officer of the West Virginia Primary Care Association, said community health centers serve more than 400,000 West Virginians and provide primary care to many individuals with substance use disorders.

“With funding through the ACA in 2016, five community health centers are now providing medication-assisted treatment to approximately 700 patients of all ages, including young adults and pregnant mothers.”

Reese said these newly established treatment programs already have long waiting lists.

“West Virginia needs significant resources to reduce this serious epidemic and medication-assisted treatment is one of several important strategies to reduce addition. Elimination of funding to support these programs would be devastating to our efforts to reduce addiction,” she said.

The Harvard Medical School and New York University analysis also notes a repeal of the ACA would damage progress made through the passage of the 21st Century Cures Act, which provides additional funding to increase treatment capacity for opioid abuse and addiction nationwide.

Repealing the ACA would eliminate approximately $5.5 billion each year from the treatment of people with substance use and behavioral health disorders, the study said.

States with the highest drug overdose death rates — West Virginia, New Hampshire and Kentucky — would see uninsured rates nearly or more than triple if the ACA were repealed. Urban Institute reports 184,000 West Virginians would lose health coverage, a 208 percent increase in the number of uninsured.

“West Virginia is one of the states that would see the one of the largest increases in its uninsured rate,” shared Aviva Aron-Dine, Senior Counselor to Secretary of HHS. “It’s mind boggling to contemplate that the uninsured rate would increase to more than they were before.”

If the repeal takes place, she pointed out hospitals will again bear the burden of uncompensated care costs greatly reduced by the implementation of Medicaid expansion. Nationwide, Urban Institute reports the newly uninsured would seek $88 billion in additional uncompensated care in 2019 — $24.6 billion of that amount from hospitals.

From 2019 to 2028, the newly uninsured would seek $1.1 trillion in additional uncompensated care, including $296.1 billion in hospital care.

Additionally, the overall well-being of West Virginia residents, who have some of the highest rates of obesity and diabetes, will likely decline without access to health care.

“The first step in getting people healthier is getting them appropriate treatment,” Aron-Dine said.

Children in West Virginia will also suffer if the ACA is repealed. According to Urban Institute and the Kaiser Family Foundation, West Virginia would lose $12.2 billion in federal Medicaid or Children’s Health Insurance Program (CHIP) funding.

“Regardless of anyone’s personal feelings about the Affordable Care Act, we need to look at the big picture,” said Rebecca Crowder, executive director of Lily’s Place. “We are facing an epidemic and those that are seeking treatment need this to remain in affect until something else is available to replace it. Loss of treatment will be detrimental to our community and the children we serve.”

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