Opioid treatment for the poor? That could die with Obamacare

Addiction to such opioid medications, such as OxyContin, along with heroin, kills tens of thousands of Americans every year.
Addiction to such opioid medications, such as OxyContin, along with heroin, kills tens of thousands of Americans every year. Los Angeles Times

California, thankfully, has never been the epicenter of the country’s opioid epidemic, but even in the state’s agricultural hubs, such as Stanislaus County, the number of people hooked on prescription painkillers and heroin is truly staggering.

There, roughly 1,100 are in treatment and 400 more are waiting to get in. The story is the same all over the Central Valley and in the sparsely populated rural north, where many voters picked Donald Trump but never would have been able to afford help curbing their addictions without the Affordable Care Act that the president-elect so detests.

It’s almost a dirty little secret – one that, shamefully, hasn’t surfaced in all of the giddy banter of the past week about ways to finally repeal and replace President Barack Obama’s signature health law. Instead, the Republican congressmen who represent these impoverished, opioid-ravaged districts have been emboldened by Trump’s nomination of Rep. Tom Price of Georgia for Health and Human Services secretary, never mind the consequences for their constituents.

Price has talked for years about getting rid of Obamacare, reneging on expanded Medicaid, and swapping it for a state-centered, market-driven law that’s almost certain to leave millions uninsured. Only time will tell if the reports of Obamacare’s death are all true or greatly exaggerated, but already the vultures are circling.

House Majority Leader Kevin McCarthy has suggested a strategy of repealing Obamacare but delaying the effective date for a few years – long enough to figure out what to replace it with. “Once it’s repealed you will have, hopefully, fewer people playing politics and coming to the table to find the best policy,” he said.

Rep. Tom McClintock, R-Elk Grove, chimed in that Republicans should “take no chances” and “do it now.” Then what?

The Affordable Care Act is far from perfect, but it has allowed millions of previously uninsured Americans to receive addiction counseling and prescription detox medication at a reasonable cost. If the plan is to gut Obamacare, what then for the people who desperately need these services?

This is a serious question that needs an answer, particularly from California Republicans, including McCarthy, McClintock and Reps. Doug LaMalfa, Jeff Denham, David Valadao and Devin Nunes. Their districts account for the majority of the more than 2,000 Californians who died of opioid overdoses in 2014.

The demand for inexpensive treatment is certainly there. At the Stanislaus County-run Behavioral Health and Recovery Services, which serves low-income patients, they have seen not only an uptick in opioid addicts seeking treatment but a 40 percent increase in people eligible for Medi-Cal under Obamacare.

Today, more than 12 million people are enrolled in Medi-Cal and about 1.57 million are enrolled in Covered California. The state’s full-throated adoption of the health law has reduced the number of uninsured Californians from 17.2 percent, one of the highest in the nation, to 8.6 percent in just three years.

Nationally, some 20 million people have gained coverage under the Affordable Care Act, reducing the nation’s uninsured rate to 8.6 percent, the lowest on record. About half of them are poor.

Those living in the 19 states with Republican governors or legislatures that have refused to expand Medicaid eligibility often face lengthy waiting lists for substance abuse treatment and, even then, are sometimes unable to afford pricey detox drugs that make it much easier to curb addiction.

On this subject – key to slowing the opioid epidemic, which killed more than 28,000 people in 2014 alone – President-elect Trump has vacillated between mute and vague. Even on the campaign trail, while Hillary Clinton and others vying for the presidency brought up opioid addiction again and again in ravaged states such as New Hampshire and Ohio, Trump spoke in broad, poorly thought-out terms.

Until October, his tone-deaf solution was to build a wall along the Mexican border to stop the flow of heroin into the United States and to deport the supposedly many “illegal immigrant drug traffickers” that the Obama administration supposedly has refused to deport – an accusation that’s patently false.

Since then, he has expanded his platform to address not only addiction to cheap heroin but the prescription opioids that start so many Americans down the path to illicit drug use and death.

He now says he wants the U.S. Food and Drug Administration to speed up the approval of detox medication, such as methadone, and wants the Drug Enforcement Administration to restrict the amount of prescription opioids that can be manufactured in the country. Above all, he adds, he wants to expand access to treatment.

He hasn’t said how he would do that, though – just that he wants to do it while eliminating the one innovation that has finally helped the most vulnerable addicts. It’s a contradiction that was on full display Thursday night in Ohio, where Trump, on his victory tour, mentioned repealing Obamacare and helping opioid addicts in almost the same breath.

In their rush to board the Trump Train and erase the Affordable Care Act, California Republicans must act as a firewall. They should demand that coverage for addiction treatment be saved, just like the provisions Trump wants to save that prevent denial of coverage to people with pre-existing conditions and let children stay on their parents’ insurance until age 26.

If there is a ground zero in the opioid epidemic, it is in Trump Country. Republicans should remember that.