GOP health care plan would cut funds for opioid and gambling addiction treatment

WASHINGTON — A Republican plan to replace the Affordable Care Act would cut mandates for coverage on addiction, prompting groups and lawmakers to urge the GOP to reconsider as their plan moves through Congress.

Specifically, the replacement plan touted by Republicans and the Trump administration would cut mandates for behavioral health and addiction services under Medicaid in states that expanded it.

Nevada was one of 31 states that expanded Medicaid, which offered coverage to roughly 11 million nationwide and about 300,000 in the Silver State.

Rep. Ruben Kihuen, D-Nev., in a House floor speech, urged Republican colleagues to restore coverage plans. He said that the current GOP plan would “undermine Medicaid funding for vulnerable Nevadans.”

“The loss of Medicaid funding in Nevada, which already has one of the highest drug mortality rates in the country, would exacerbate our opioid epidemic and make the state’s public health challenges even more serious,” Kihuen said.

According to the Nevada Department of Health and Human Services, the opioid addiction epidemic is a public health issue for Nevada. Deaths from opioid use are outpacing fatalities from motor vehicle accidents.

The 22.4 deaths per 100,000 population attributed to opioids in Nevada in 2015 was nearly twice the national average of 13.5 per 100,000. Heroin overdose deaths in Nevada have risen from 19 in 2010 to 52 a year ago, according to a Centers for Disease Control report in 2016.

States differ on coverages for addiction under the ACA, according to the CDC, which does not have a state-by-state breakdown on coverages for such services.

But Nevada is one of the few states that included overdose and withdrawal drugs for addiction under its Medicaid expansion.

Other behavioral problems also are covered. Overall, there are about 20,000 Medicaid behavioral or substance abuse patients in Nevada, according to the state’s health department.

The American Gaming Association, which represents the $240 billion casino industry in 40 states, said gambling disorders are recognized under the ACA as behavioral health problems eligible for benefits and treatment.

In a letter to House and Senate leaders and Health Secretary Tom Price, gambling industry leaders, including Geoff Freeman, president and CEO of the American Gaming Association, said “we would be concerned with any paring back of essential health benefits that eliminates ‘gambling disorders.’”

They said recognition of gambling disorders is needed in the replacement legislation to provide adequate funding for research, “but also to ensure necessary resources and treatment facilities are available for those struggling with problem gambling disorders.”

President Donald Trump and Price continued their coordinated effort to sell lawmakers in the House and Senate on the GOP replacement plan that passed through committees last week despite objections from Democrats and Republicans alike.

Trump met at the White House on Monday with “victims” of the ACA — commonly referred to as Obamacare — which mandated coverage for everyone. The law provided subsidies for those eligible by income to purchase coverage plans.

None of the people, who told stories about mishaps and difficulties under Obamacare, were from Nevada.

One woman, Carrie Couey from Colorado, said her insurance rates are “three times” higher than when Obamacare began. She said that has hurt her family cattle ranching business.

“We can’t afford our equipment if we’re paying these rates year after year after year. Our food source is in jeopardy because of this health care law,” she said.

Trump said the “press is making Obamacare look so good suddenly. I’m watching the news.”

“It looks so good,” Trump said, “…first of all, it covers very few people and it’s imploding. And ’17 will be the worst year.”

Trump said Obamacare was failing, and would have collapsed on its own. He has noted mergers of insurance providers and the rising cost of insurance premiums on public and employer-sponsored plans.

But in an earlier speech to Congress, the president also vowed to back states’ efforts to battle the opioid epidemic that has spread across the country.

Republican lawmakers, including Senate Majority Leader Mitch McConnell, R-Ky., and Sen. Lisa Murkowski, R-Alaska, and Sen. Rob Portman, R-Ohio, have argued against cutting Medicaid expansion of funds to combat mental health and addiction treatment services.

GOP lawmakers who want to retain Medicaid expansion stand in contrast to budget hawks in the Republican Party who want to see a full repeal of the Obamacare to save taxpayer dollars.

Contact Gary Martin at 202-662-7390 or gmartin@reviewjournal.com. Follow @garymartindc on Twitter.