Obamacare repeal would affect Pennsylvania’s fight against opioids

March 16--The pending House Republican plan to replace the Affordable Care Act would affect which tools are available to states like Pennsylvania as they combat the national opioid epidemic.

The changes are related to how the proposal seeks to revamp Medicaid, which provides health coverage for low-income and disabled individuals. First, states like Pennsylvania that expanded their Medicaid programs would no longer be required to include mental health or addiction services.

The Medicaid program also would be funded differently. Instead of open-ended funding from the federal government, states would receive a set amount for each person enrolled. Supporters say the change would give states more flexibility, though Pennsylvania Gov. Tom Wolf and other critics of the plan say it would affect which medical benefits are offered.

"Cutting funding to Medicaid would just force states like Pennsylvania into a horrible choice of which vulnerable populations to give access to care and which to leave helpless," Wolf wrote to House Speaker Paul Ryan in January, before the bill was introduced.

Wolf's administration says that of the 700,000 Pennsylvanians who gained coverage through the expansion of Medicaid, 63,000 have accessed drug or alcohol treatment services.

A report released ahead of the House GOP bill's announcement identified more than 180,000 Pennsylvanians with mental and substance abuse disorders as potentially losing access to services if the repeal is approved.

Nearly 100,000 residents are covered through the Obamacare marketplace insurance, concluded Harvard health economics professor Richard G. Frank and New York University public service dean Sherry Glied. The remaining 81,000 residents receive coverage through the expansion of Medicaid outlined under the Affordable Care Act.

Nationwide, repeal would cut at least $5.5 billion in federal funding, the researchers found.

Democrats, including U.S. Sen. Bob Casey, have cited the opioid fight as they oppose the GOP repeal-and-replace measure, arguing that fewer people would receive substance abuse treatment.

A push from conservative lawmakers also would accelerate when the Medicaid changes go into effect.

While the changes are not proposed to affect the program until 2020, some conservatives have sought to move them up to January 2018. Centrist Republicans in the U.S. House, such as Rep. Charlie Dent, who represents much of the Lehigh Valley, have expressed concerns about the Medicaid changes and opposed enacting those policies sooner.

As state officials watch to see what happens with Medicaid, one Pennsylvania Republican lawmaker pushed to add a provision that could give them additional dollars specifically for mental health and addiction treatment.

U.S. Rep. Tim Murphy, a Republican from Allegheny County, had pushed for a $100 billion fund available to states for a range of uses include up to $15 billion to expand access to mental health and addiction. Murphy described the provision as going "further" than the Affordable Care Act did on prevention, treatment and recovery.

"The American Health Care Act reflects our commitment to deliver treatment before tragedy," Murphy said.

The opioid epidemic has been felt throughout the Lehigh Valley: 59 people died of accidental overdoses involving heroin or other opiates in Northampton County in 2014 and 2015, and 40 died in Lehigh County over the same time period.

Reporter Sam Kennedy contributed to this report.

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