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Thousands of Philadelphians could face new challenges paying for substance abuse treatment if the Senate GOP’s healthcare plan becomes a reality.

While the Senate GOP’s healthcare bill sets aside funding to address the opioid crisis, some activists and Democrats, along with the City of Philadelphia itself, have expressed concerns that the bill’s cuts to Medicaid funding could still dramatically impact access to treatment services for those with opioid use disorders, especially those who use Medicaid to pay for treatment.

Pennsylvania Democrat Gov. Tom Wolf’s administration estimates that the Affordable Care Act led to an additional 175,000 Pennsylvanians receiving some form of substance abuse treatment or services. And there are an estimated 40,000 people in Philadelphia alone who received city behavioral treatment over the last two years — including for substance abuse — who were newly covered under expanded Medicaid.

Opponents say this bill could put all that in jeopardy.

The possible impact on PA and Philly

A woman protests outside Sen. Pat Toomey’s office. Credit: Anna Orso/Billy Penn

First things first: The Senate GOP’s plan, A.K.A. the Better Care Reconciliation Act, currently sets aside $2 billion in 2018 for state grants to fund treatment and recovery services. There’s speculation that Senate leadership could set aside some additional $40 billion more to address the opioid epidemic to satisfy some senators from states hit hard. (Though even Ohio’s Republican Gov. John Kasich said a few billion dollars won’t begin to address the problem nationwide, and is “like spitting in the ocean.”)

The Congressional Budget Office has estimated the BCRA would reduce projected Medicaid spending by $772 billion over the next decade and could significantly roll back the expansion of Medicaid, which was adopted by Pennsylvania in 2015. Over the course of a decade or more, the BCRA would place more responsibility on states to cover costs associated with Medicaid.

Medicaid expansion provided health insurance to an additional 700,000 Pennsylvanians since 2015, bringing the total number of Pennsylvanians covered by Medicaid to more than 2.7 million. In Philadelphia alone, 650,000 people (or 40 percent of the city) rely on Medicaid for their health coverage, 166,000 of whom were newly eligible under Medicaid expansion.

In Philadelphia, almost 25 percent of new Medicaid enrollees — or about 40,000 people — are using city behavioral health services, including substance use disorder services. The city contends that eliminating or cutting funding for Medicaid expansion “will either cut these people off from services or force the City to incur huge financial costs for their treatment, or both.” City officials didn’t provide requested data regarding the number of new Medicaid enrollees receiving treatment for an opioid addiction specifically.

There are an estimated 55,000 people in Philadelphia alone using injectable drugs. Last year, more than 900 people died of a drug overdose in Philadelphia, and the city is on track to see 1,200 overdose deaths this year.

Republicans who support the BCRA point out that in addition to the $2 billion set aside in the legislation, the bill also expands federal Medicaid reimbursements for inpatient psychiatric hospital services. While it doesn’t go as far as some advocates want it to, the GOP contends this is a significant change in federal policy, and it’s a change Wolf asked for in a May 30 letter to Republican U.S. Sen. Pat Toomey. Here’s that letter in full:

[scribd url=”https://www.scribd.com/document/349859384/Letter-to-Senator-Pat-Toomey#from_embed” /]

Toomey’s camp says the senator, who’s on record saying funding to address the crisis will increase, is open to any proposal that would expand access to addiction treatment. When asked this week whether or not the bill’s cuts to Medicaid would jeopardize efforts to combat the opioid crisis, Toomey was skeptical.

“I don’t think that’s actually the case, but I think you’re going to see a significant increase in the effort to deal with this,” Toomey said, according to The (Allentown) Morning Call.

Why Dems say funding doesn’t go far enough

Democrats say even a large increase in funding for addiction treatment still places a heavier burden on states dealing with cuts to Medicaid under the legislation and will require states to dip into reserves they don’t have.

Wolf, a Democrat whose crowning achievement in his first term might be the fact that he expanded Medicaid, has traded letters for months with Toomey, a Republican who is among the top senators charged with drafting the BCRA. State Attorney General Josh Shapiro, also a Democrat, has done the same.

BCRA opponents also point out that Pennsylvania opened a few dozen “Centers for Excellence” across the state — they’re state- and federally-funded centers that connect Medicaid enrollees struggling with opioid addiction with behavioral health providers and other services. A loss of funding could theoretically strain these centers and limit the services they’re able to provide.

U.S. Sen. Bob Casey, a Pennsylvania Democrat, has been particularly outspoken, sending out more than a dozen tweets picking apart the bill. Casey said in a statement the Senate GOP’s plan “takes away coverage for substance abuse treatment” and would “cripple our efforts to battle opioid addiction in our country.”

Casey teamed up with West Virginia Democrat Sen. Joe Manchin to release a report of sorts that examines how GOP healthcare plans would impact the opioid crisis in Pennsylvania. It’s worth noting: The not-at-all-nonpartisan report was released before the Senate GOP’s healthcare bill was made public.

In the report, Casey contends that “Pennsylvanians who gained opioid treatment coverage through Medicaid expansion could be left without care.”

According to the report, Medicaid provides coverage for more than a third of people with opioid use disorders and, in Pennsylvania, Medicaid pays for about 30 percent of all prescriptions for buprenorphine, a medication similar to methadone that’s used to treat opioid addiction. Here’s that report in full:

[scribd url=”https://www.scribd.com/document/352614708/Casey-Opioid-Report” /]

The Urban Institute released a study last week that showed spending on Medicaid-covered prescriptions used to treat opioid addiction and overdoses increased from $394 million to $930 million in just five years between 2011 and 2016.

In Pennsylvania, spending increased from $37 million $84 million between 2011 and 2016. That’s a 127 percent increase over five years.

Anna Orso was a reporter/curator at Billy Penn from 2014 to 2017.