This article is more than 5 years old. Information may no longer be current.

ACA repeal could worsen opioid epidemic

Americans with opioid use disorder who require treatment could face difficulties receiving treatment if the Affordable Care Act is repealed, according to a perspective recently published in the New England Journal of Medicine.

As the discussions for a replacement to the Affordable Care Act (ACA) get underway, the authors expressed hope that President Donald J. Trump remembers that during his campaign, he stated he would increase access to assistance programs and help those that are addicted.  

“Although the Affordable Care Act was not designed with the opioid epidemic in mind, it provides valuable tools for expanding access to medication treatment,” Peter D. Friedman, MD, MPH, University of Massachusetts Medical School, Springfield, and colleagues wrote.

One tool the ACA provided was the expansion of the 2008 Mental Health Parity and Addiction Equity Act to include Medicaid expansion programs, state health insurance marketplaces and all private plans.

“Parity requirements mandate that insurance-benefit limits on addiction treatment are no more restrictive than those applied to other medical and surgical services. Parity protections are critical to ensure access to adequate treatment without unfair out-of-pocket costs and limits on the frequency and duration of services,” the authors wrote, adding that a repeal of this ACA component would place "restrictive and inequitable" limits on supplementary and medication treatments for opioid use disorder.

Another tool, according to the authors, was designating addiction treatment “an essential health benefit,” thus mandating qualified health plans offered on state health insurance marketplaces and Medicaid expansion programs cover some form of treatment for opioid use disorder. Removing that designation would make extended-release naltrexone and buprenorphine, two commonly prescribed medications for opioid addiction, cost-prohibitive for many uninsured Americans.

Taken collectively, these casualties of a repeal mean millions of Americans could face significant obstacles receiving addiction treatment

The authors also wrote that an ACA repeal would significantly hurt rural areas, because these areas are where the opioid epidemic has hit hardest, but also because these areas are where the largest expansions in Medicaid have taken place since ACA's adoption.

“The opioid epidemic cuts across the lines of political polarization, touching nearly every community in this country,” Friedmann and colleagues wrote. “All of them will lose if the ACA is repealed and not replaced by a plan with comparable coverage and parity for treatment of opioid use disorders.”

The authors noted that while running for president, Trump said he would not ignore those with addictions, saying he would get help for those addicted and increase access to treatment.

"We hope that he will live up to his campaign promises," Friedman and colleagues wrote.  

Earlier this week, the House unveiled a plan to replace ACA, American Health Care Act, which faces criticism from both Republicans and Democrats. The proposed legislation now goes onto the Congressional Budget Office for analysis.

Ahead of any legislative action, many of the involved health care entities are taking action to address different aspects of the opioid epidemic Some insurance companies have taken steps to combat the opioid crisis, such as ending prior authorization for medication-assisted treatment, asking their member practices to lower the amount of opioids dispensed and improving pain management and substance use treatment where appropriate.

In addition, researchers recently identified some possible “building blocks” for better opioid prescription management and the CDC has released opioid prescription guidelines for primary care physicians.

Since the start of the year, the FDA has approved several medications targeted to address the ongoing opioid abuse crisis, with new pain relief agents that are manufactured in a manner to limit abuse. – by Janel Miller

Disclosure: Friedmann reports personal fees from Indivior and non-financial support from Alkermes and Braeburn outside the submitted work. The other researchers report no relevant financial disclosures.