Author: Justin Mckibben
It is no secret that the devastating opioid epidemic in America is still tearing a path of despair across the country. In 2015 this ongoing public health crisis ravaged communities, causing over 52,000 drug overdose deaths and more than 33,000 opioid overdose deaths. The opioid problem was a major campaign issue during the election, and now is one of the most pressing problems we face here in the states. Yet, upon examining the recent budget proposal released by President Trump and his administration, it seems the means to try and bring the epidemic to an end are lacking to say the least.
Given the current state of affairs, it is certain that tens of thousands of people will likely die of drug overdoses under President Donald Trump’s term. Taking that into account many hoped that drug treatment would be a serious priority. However, with the first big policy document from President Trump being the 2018 budget proposal, experts believe Trump is proving that the opioid crisis is not a priority. All this after claims that Trump would “spend the money” in order to “end the opioid epidemic in America.”
If anything, some experts are saying the proposal President Trump has introduced may actually make the opioid epidemic worse. So here we will take a look at some of the pros and cons of the 2018 proposed budget.
The Pros VS the Cons
According to the Office of National Drug Control Policy (ONDCP), this new budget plan makes little effort, and in the end it may ultimately prove obsolete.
Nearly 2% increase in drug treatment spending
Pro- the ONDCP says this will amount to an estimated $200 million added to the already $10.6 billion the government already spent on treatment.
Con- the catch is this money includes the $500 million added by the 21st Century Cures Act from the Obama administration.
That essentially means without that Obama era legislation the Trump budget would have actually cut drug treatment spending. Ultimately, the cut will likely happen the year after the 2018 budget because the Cures Act money is only for 2017 and 2018.
Cuts or No Cuts?
Pros- Still, according to the ONDCP figures of the 2018 budget, technically there are no proposed cuts to overall drug treatment spending this year.
Cons- However, the proposal does suggest other cuts to public health and anti-drug programs. The ONDCP states that these other cuts in funding can completely undermine any progress.
For example, the 2018 budget proposal from President Trump does seriously cut drug prevention programs across all federal agencies by approximately 11%.
Other Big Budget Debates
Probably one of the big arguments is the potential for problems with healthcare and cuts to Medicaid, especially since President Trump repeatedly ran on the promise that he would not be cutting Medicaid.
However, reports indicate Trump also proposes a 47% cut to Medicaid over the next 10 years! People have been up in arms about the suggestion that this could potentially strip the one affordable source of health insurance from millions of Americans. Part of which is actually used for drug addiction treatments.
A 2014 study showed that Medicaid paid for ¼ of projected public and private spending for drug treatment in 2014. That equates to around 7.9 billion dollars utilized for treating drug addiction.
The new 2018 budget proposal also requests nearly $400 million worth of cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA)
Mental Health Block Grants
The Trump budget requests hundreds of millions of dollars to be taken away from mental health block grants.
Beyond that, the budget calls for billions of dollars to be cut from agencies and programs that work to help address the opioid epidemic and drug addiction. Agencies with proposed cuts include:
- The National Institutes of Health (NIH)
- Centers for Disease Control and Prevention (CDC)
- Food and Drug Administration (FDA)
While these are not drug treatment providers, they are actively involved in creating opportunities and providing research in the mental health and drug treatment communities.
Too Little Too Late
Advocates for drug treatment don’t only put this on Trump. For years the federal government has taken too long to take action to fight the epidemic. Even with the Obama administration it took until 2016 to pass any major legislation. Finally the 21st Century Cures Act added $1 billion to drug treatment for 2 years, but advocates insist that the problem requires much more funding.
This makes sense, considering the overdose outbreak now kills more people than:
- Even HIV/AIDS at the peak of its outbreak
Examining the budget shows that the only significant action in the budget that would affect the epidemic is cuts in funding to important elements in the fight against the epidemic. Sadly, as far as anyone has stated, there is nothing in the budget to balance out the cuts either.
What We Know
The fundamental issue is that America needs to put a lot more resources into drug addiction prevention and drug addiction treatment. The Obama administration took some steps in 2015 and 2016 to add hundreds of millions and then another billion to fund the efforts, but experts still say that was also too little too late.
The fear now is that more needs to be done to empower the agencies that are on the front lines of the fight. More needs to be put into a compassionate response. Instead, Trump’s Attorney General Jeff Sessions is advocating for a “tough on crime” attitude and endorsing the War on Drugs that has already failed the nation time and time again.
So while there is potential, and many believe Trump has an amazing opportunity to do much more than his predecessor did to create resources for battling the opioid epidemic head-on, many see these recent steps as an indication that things might get worse before they get better.
Drug abuse and addiction is a devastating and deadly disease, and providing effective and compassionate treatment makes a lifelong difference. If you or someone you love is struggling with substance abuse or addiction, think about who you want to be working with to find a real solution. Please call toll-free now.
Author: Justin Mckibben
The new Trumpcare plan, formally known as the American Health Care Act or AHCA was announced this Monday March 6th. This Trumpcare bill is the Republican Party’s long awaited plan to repeal and replace the Affordable Care Act, also known as Obamacare.
Since day one of the announcement we have seen quite a few varying opinions as to what this means for the people who were previously covered, and what it means for how healthcare altogether might change. Needless to say, not that much of the talk has been optimistic. As details emerge about Trumpcare some have become increasingly worried about the impact it will have on access to treatment for substance use disorder, especially for low-income Americans.
So what some are officials and experts saying about Trumpcare, and what it might mean for Americans struggling with addiction?
Early Predictions on Trumpcare
According to some early reports, 6-10 million Americans will lose health insurance. Not only that, millions of people in desperate need of help could be cut off from access to addiction treatment as a result of the bill.
In fact, according to one analysis, approximately 2.8 million people living with substance use disorder will lose some or all of their health insurance coverage if Obamacare is repealed. This conclusion comes from:
- Harvard health economist Richard Frank
- Sherry Glied, Dean of the Wagner School of Public Service at NYU
The publication The Hill reported in January that Frank and Glied predict that the federal government’s 21st Century Cures Act creates a recent investment of $1 billion to tackle opioid abuse. However, they state this provision would be- “squandered if the new Congress rolls back recent gains in the quality and level of substance use and mental health insurance coverage generated by the Affordable Care Act (ACA) of 2010.”
Surely this is all “fake news” and “alternative facts” right?
Not so much. According to reports from the Washington Post Thursday, House Republicans admitted, after questioning by Massachusetts Democratic Representative Joe Kennedy III, that their the Trumpcare plan to repeal-and-replace would- “remove a requirement to offer substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans.”
How does this happen? By attacking the expansion of Medicaid and the ‘essential benefits’ states are required to provide for.
Trumpcare Impact on Medicaid
Trumpcare’s plan to roll back Medicaid and health insurance tax credits are pretty distressing aspect of this reform. For all the Americans who rely on government assistance for addiction treatment this is a pretty huge deal.
Addiction treatment in the past is notably impacted by Medicaid. According to Truven Health Analytics, Medicaid was the second largest payer for addiction treatment, after state and local programs, in 2014.
Starting in 2020, Trumpcare is set to:
- Freeze Medicaid enrollment
- No longer require Medicaid to cover essential health benefits like addiction treatment
What is the point? To make it so the federal government pays less for Medicaid over time by shrinking coverage.
So if this is all the case, it is a terrifying reality. In a time when more Americans than ever desperately need addiction treatment, in the midst of an opioid epidemic that is tearing families and communities apart, the government’s Trumpcare plan stands to save money by stripping addiction resources from those relying on Medicaid?
Representative Kelly and Peter Welch, Democratic Representative from Vermont, attempted to amend the bill to restore the federal mandate for those ‘essential benefits’ but were voted down. Kenny is popularly quoted in the news recently for his statement,
“There is no mercy in a country that turns their back on those most in need of protection: the elderly, the poor, the sick, and the suffering. There is no mercy in a cold shoulder to the mentally ill… This is not an act of mercy — it is an act of malice.”
While Trump’s comments say he wants to give states “flexibility” with Medicaid to make sure no one is left out, many believe this is just adding the idea of paying more for less.
Senate Minority Leader Chuck Schumer vows to lead efforts to defeat Trumpcare, stating he believes it will “Make America Sick Again” and believes that it will create more drug addicts. In a report from The Hill Schumer attacks the bill saying,
“To make matters worse, this sham of a replacement would rip treatment away from hundreds of thousands of Americans dealing with opioid addiction, breaking the President’s word that he would expand treatment, not cut it.”
This is continuously troubling. When it comes to the fight against addiction, President Trump’s administration seems to be more focused on borders and “law and order” than providing resources. Trump did promise to work on creating more coverage options, but all the action taking place almost points the opposite direction.
Trumpcare Impact on Treatment Providers
This chain reaction wouldn’t just hurt those who need insurance by denying them coverage. Experts say Trumpcare also has the capacity to do damage to the treatment providers themselves.
Keith Humphreys, a drug policy expert at Stanford University, points out this issue directly. Humphreys notes that treatment providers, which tend to be small businesses in many parts of the country, may find it difficult to stay in business if clients lose coverage for addiction treatment. If less people are able to get coverage, less people will be able to get treatment. At the same time even bigger treatment providers could have trouble because it still has the capacity to reduce reimbursement rates for treatment services.
Thus, Trumpcare could affect both the supply and quality of treatment. In one interview Humphreys states,
“Most providers are small, mono-business entities that can’t absorb costs elsewhere in their care systems,”
“While hospitals will not go broke if poor people get less oncology care coverage, many [substance use disorder] treatment agencies will.”
But it isn’t just Democrats or University Professors or addiction experts speaking out. The AARP, the American Hospital Association, and the American Medical Association voice opinions against the overhaul of the ACA and the potential harm Trumpcare could do.
Even Republicans are speaking out against the danger that Trumpcare poses to addiction. Ohio Governor John Kasich is vocal with his own opposition to the bill saying,
“[Trumpcare] unnecessarily puts at risk our ability to treat the drug-addicted mentally ill and working poor who now have access to a stable source of care.”
Not to say that healthcare was ever perfect. It is noted by many doctors in the addiction field, as well as politicians and other experts, that there is already a treatment deficit. Approximately 10% of America’s population has what could be considered a substance use disorder, and only 13% of those people ever get treatment.
However, the miles of red tape Trumpcare might wrap around them could cut that number drastically. So even if these are unintended consequences, they are very real consequences just the same.
Obamacare was far, far from perfect. This is absolutely true. But is Trumpcare the best answer we can come up with?
As it now stands, Trumpcare may take so much away from those struggling with addiction and mental health that some experts are calling it dangerous. Having safe, effective and comprehensive treatment resources for these issues is extremely important to the preservation of life and the future of America. This is a matter of life and death. It is not the time for an ‘anything but Obamacare’ mentality… if the government expects a better plan, they need to make it happen. How about we put a hold on spending billions on border walls and expanding the nuclear program, and instead focus on healing Americans who need it most.
If you or someone you love is struggling with substance abuse or addiction, think about who you want to be working with to find a real solution. Please call toll-free now.
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