Breaking News
June 24, 2018 - Enlist a Pharmacist to Help Manage High Blood Pressure
June 24, 2018 - Genes found related to the reduction of proteins that contribute to Alzheimer’s onset
June 24, 2018 - 1 in 5 immigrant children detained during ‘zero tolerance’ border policy are under 13
June 24, 2018 - Personal automated cell lab assistant from Leica saves time with quality results
June 24, 2018 - Drug use can have social benefits, and acknowledging this could improve rehabilitation
June 24, 2018 - AMSBIO introduces MyEZGel 3D-iPSC Matrix for more accurate in vivo predictions
June 24, 2018 - RaySearch releases new RayStation 8A to expand support for TomoTherapy platform
June 24, 2018 - Dying cancer cells make remaining glioblastoma cells more aggressive and therapy-resistant
June 24, 2018 - Researchers discover new type of cell that hinders formation of fat cells
June 24, 2018 - Scientists develop unique program to predict a form of Parkinson’s disease
June 24, 2018 - Adult Obesity Prevalence Varies With Level of Urbanization
June 24, 2018 - Picking an exercise boot camp
June 24, 2018 - Researchers outline a connection between subplate neurons and brain disorders
June 24, 2018 - Four cups of coffee a day shown to protect heart muscle
June 24, 2018 - ‘Antifreeze’ molecules may hold key to better treatments for brain injuries
June 24, 2018 - Opening onsite health clinics for workers can cut health care costs
June 24, 2018 - Glooko to demonstrate new version of diabetes management mobile application at ADA meeting
June 24, 2018 - Florida Teen First Human Case of Another Mosquito-Borne Virus
June 24, 2018 - Blood type O patients may have higher risk of death from severe trauma
June 24, 2018 - New studies on molecular and cellular proteomics
June 24, 2018 - Algorithm predicts dangerous low blood pressure during surgery
June 24, 2018 - Herpes may play role in pathogenesis of Alzheimer’s
June 24, 2018 - Inaccurate measurement of sodium intake may account for paradoxical results, study suggests
June 24, 2018 - Aquinnah Pharmaceuticals wins NINDS grant to advance novel therapies for ALS
June 24, 2018 - Study upends conventional view of opioid mechanism of action
June 24, 2018 - Floppy eyelids may be sign of sleep apnea, study finds
June 23, 2018 - Researchers highlight new nurse training model to address shortage of primary care
June 23, 2018 - New Olympus cellSens 2.1 speeds up image analysis
June 23, 2018 - Attitudes Among Obese Are Not Aligned With Healthy Living
June 23, 2018 - Early birds less prone to depression
June 23, 2018 - Scientists use novel approach to uncover how brain networks interact to make word-choice decisions
June 23, 2018 - Researchers discover shared genetic basis for psychiatric disorders
June 23, 2018 - Study shows fat cells increase in size and number upon exposure to fracking chemicals
June 23, 2018 - Water-limited landscapes can facilitate disease transmission
June 23, 2018 - Exercise May Ease Inflammation Tied to Obesity
June 23, 2018 - Is it their own fault?! How people judge the exclusion of others
June 23, 2018 - Researchers use advanced technology to identify proteomes of Th17 and iTreg cells
June 23, 2018 - Researchers develop low-cost plastic sensors to monitor wide range of health conditions
June 23, 2018 - Lipid-scrambling DNA enzyme outperforms naturally occurring counterpart, say researchers
June 23, 2018 - Apps for children should emphasize parent and child choice, researchers say
June 23, 2018 - Teenage girls report higher degree of daytime sleepiness than boys
June 23, 2018 - Protein Data Bank at Rutgers impacts research, education and drug discovery
June 23, 2018 - Study unravels new piece of information in the Huntington’s disease puzzle
June 23, 2018 - Scientists develop new device to test cancer drug combinations quickly and cheaply
June 23, 2018 - Neural Analytics wins CE Mark for NeuralBot System
June 23, 2018 - Infant omega-3 supplementation tied to decreased waist size
June 23, 2018 - Massive analysis of genomes reveals insights into genetic overlap among psychiatric diseases
June 23, 2018 - New therapeutic approach may delay neurodegeneration in rare genetic disease
June 23, 2018 - Broken shuttle protein may hinder learning in patients with brain disorders
June 23, 2018 - Study finds increase in daily cannabis use among American adults
June 23, 2018 - Researchers create electronic skin that brings back real sense of touch to prosthetic limbs
June 23, 2018 - FIRS: Guidance Offered for Protecting Youth From E-Cigarettes
June 23, 2018 - Scientists unravel molecular mechanisms of Parkinson’s disease
June 23, 2018 - When the Heart Stops, Drugs Often to Blame
June 23, 2018 - Scientists show that a key Parkinson’s biomarker can be identified in the retina
June 23, 2018 - Study finds factors underlying current rise in radicalization among European youth
June 23, 2018 - New study finds higher heart disease risk in bisexual men
June 23, 2018 - Coconut oil diet increases vitality, lifespan of fruit flies with peroxisomal disorder
June 23, 2018 - Jumping genes or transposons and their role in the genetic code
June 23, 2018 - The Current issue of “The view from here” is concerned with Therapeutics
June 23, 2018 - Abnormal lipid metabolism in fat cells predicts future weight gain and diabetes in women
June 23, 2018 - Alcohol problems linked to sex without condom use among black gay men
June 23, 2018 - DNA patterns in circulating blood cells can help identify spastic cerebral palsy
June 23, 2018 - Unsubstantiated health claims widespread within weight loss industry
June 23, 2018 - FDA grants marketing authorization for use of two catheter-based devices in hemodialysis patients
June 23, 2018 - An ingrown toenail not the same as a bypass
June 23, 2018 - Study suggests proteinuria lowering as important target in managing pediatric CKD
June 23, 2018 - Dynamic model helps make predictions about gut microbiome
June 23, 2018 - Research consortium wins £2.9 million to help tackle antibacterial resistance in Thailand
June 23, 2018 - Schizophrenia patients account for over 1 in 10 suicide deaths, study shows
June 23, 2018 - Overdose risk increases five-fold with concurrent opioid and benzodiazepine use
June 23, 2018 - FDA Alert: Kratom (mitragyna speciosa) powder products by Gaia Ethnobotanical: Recall
June 23, 2018 - Study highlights inadequate effort of health care insurers to combat opioid epidemic
June 23, 2018 - CDC chief asks for, and gets, cut to his record $375K pay
June 22, 2018 - Novel cellular pathway may clarify how arterial inflammation develops into atherosclerosis
June 22, 2018 - Pioneering exercise program improves physical, mental health of elderly people living in care homes
June 22, 2018 - Rutgers Cancer Institute educates childhood cancer survivors about late effects of treatment
June 22, 2018 - Study tests accuracy of device designed to detect heart dysfunction in childhood cancer survivors
June 22, 2018 - Study links annual haze with increased hospitalizations for respiratory problems
June 22, 2018 - Robotic surgery appears to be as effective as open surgery in treating bladder cancer
Scaling back Obamacare will make the opioid crisis worse

Scaling back Obamacare will make the opioid crisis worse

image_pdfDownload PDFimage_print

There’s been much talk in the U.S. about fixing the opioid crisis.

In October, President Donald Trump declared the situation a public health emergency and set up a commission on opioids. On Feb. 9, Congress finally took action by allocating US$6 billion for substance abuse treatment in the budget bill. Though a step in the right direction, many experts argue that it’s still a drop in the bucket given the extent of the epidemic.

These funds will undoubtedly help states expand substance abuse services, but their impact will depend on the robustness of our current health care system. As a social worker who has witnessed addiction firsthand, I know the country needs a health care system that treats the whole person, rather than just his or her substance use disorder.

This concept drove many provisions of the Affordable Care Act, which seeks to improve access and quality of services for people suffering from drug dependence. The ACA also promotes integrated health care, the systematic coordination of physical and behavioral care.

By undermining the ACA, Trump and the GOP are taking away one of the health care system’s best tools for improving the lives of those with addiction.

ACA and access to care

When the ACA passed in 2010, 62.5 million people gained access to mental health and substance abuse services for the first time.

By requiring that the essential benefits package include equal coverage for health and behavioral health conditions for both inpatient and outpatient care, the ACA significantly increased the reach of a 2008 law that applied only to big employer plans.

Many Americans also gained access to mental health and substance use benefits if their states opted to expand Medicaid under the ACA. By 2015, Medicaid covered 38 percent of the 2 million people with opioid dependence. However, that still left 20 percent uninsured, many of whom live in states that didn’t expand Medicaid.

With greater access has come increased treatment rates. Clinics under the National Council on Behavioral Health Care now treat 30,000 people a year for substance use disorders, versus 9,000 prior to the ACA. Many states expanded their Medicaid programs to include medication-assisted treatment, an effective approach that combines medication, such as Naltrexone or methadone, with counseling.

However, some Republicans go so far as to claim that Medicaid expansion caused the opioid epidemic. Drug-related deaths have continued to rise and are higher on average in states that expanded Medicaid under the ACA. People on Medicaid are also more likely to be on pain medication.

But the fact that more people are on pain medication does not prove that more people on Medicaid misuse opioids. People on Medicaid have more chronic conditions and pain than the general population and require more pain treatment. Moreover, these state trends in drug-related deaths were well-established before 2010, when the ACA went into effect.

Altogether the data show that, while access to health care is a necessary step, it’s not sufficient to solve the problem. What also matters is the way we deliver care.

Substance use and physical health

In addition to improving access and coverage, the ACA aims to redesign the way Americans receive health care.

Physical and mental health are intertwined, but our health care system has long treated symptoms in isolation. There are even separate government agencies to oversee health, mental health and substance abuse services at the federal, state and local level.

Opioid dependence is arguably one of the most egregious examples of the damage wrought by treating one symptom without considering the whole person. During the crisis, new cases of hepatitis C from opioid use tripled, Indiana experienced an HIV outbreak and deaths from overdose skyrocketed. People with substance use disorders are at high risk for other ailments, such as heart disease, asthma, gastrointestinal disorders and skin infections.

Yet behavioral health care providers have neglected the physical health needs of the people with mental health and substance use disorders, leading to alarming mortality rates. Conversely, primary care providers have not paid attention to behavioral health. In the case of opioid addiction, this has led to dangerous prescribing practices to manage pain.

People with substance use disorders and mental illnesses make 12 million visits annually to emergency departments. These visits and subsequent hospitalizations are predominantly for medical care, not psychiatric care, and most importantly could often have been prevented with good primary care.

Under the ACA, millions of federal dollars have been awarded to health care systems find innovative ways to integrate care. For example, accountable care organizations are groups of hospitals, doctors and other providers who take on the cost of caring for an enrolled population and can share any savings they generate. Some models go further by actually locating primary and behavioral health clinics together, so people can have a one-stop shopping experience for all their health needs.

Such models provide financial incentives for systems to coordinate primary and behavioral care. Early evidence suggests that accountable care organizations improve the quality of care and reduce hospitalizations.

The ACA also increased funding for preventive services, such as screenings for substance abuse in community settings.

Danger ahead

During the 2016 elections, the repeal of the ACA became a rallying cry for Trump.

Yet Congress has not managed to overturn it. Instead, the attack on the ACA has become piecemeal. Trump has cut funding to promote enrollment in marketplace insurance, offered states the option to implement Medicaid waivers that undermine benefits and constantly threatened to cut cost-sharing payments to insurers.

The most significant attack came recently as part of the tax overhaul bill. This bill repealed the individual mandate, meaning people can no longer be penalized for not having health care insurance. Many experts are concerned that this will exacerbate the fragility of insurance markets. Furthermore, the bill eliminated key health care taxes that fund innovation to improve service quality and reduce costs.

While we have seen the opioid epidemic rise under the ACA, the crisis could have been worse without it. What’s more, system integration is complicated and takes time. Even with the full support of the administration, Americans would not have seen the full benefits of these reforms yet.

Explore further:
More access to opioid treatment programs needed in Southeast, says study

Provided by:
The Conversation

Tagged with:

About author

Related Articles