At first meeting of Trump’s opioid commission, health advocates plead for Medicaid spending

WASHINGTON — Health advocates on Friday used the first meeting of President Trump’s commission on the opioid crisis to criticize a bill that would slash future Medicaid spending and deregulate the health insurance market, arguing that the legislation would undermine whatever progress the panel could make.

“Medicaid is the largest national payer for addiction and mental health treatment,” said Dr. Joe Parks, the medical director for the National Council for Behavioral Health. “Since the majority of increased opiate deaths and suicide occur in young and middle-aged adults, which is the [Medicaid] expansion population, the Medicaid expansions must be maintained and completed.”

His audience at the first meeting of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey Gov. Chris Christie, included Health and Human Services Secretary Tom Price, top White House advisers Kellyanne Conway and Jared Kushner, and Secretary of Veterans Affairs David Shulkin.

A pending bill in the Senate is expected to call for slashing federal Medicaid funding and rolling back expansions put into place in recent years by the Affordable Care Act. A version of the bill passed by the House would reduce planned Medicaid spending by $880 billion over the next decade.

“Medicaid, essential health benefits, parity, parity, parity,” said Gary Mendell, the CEO of the addiction-focused nonprofit Shatterproof, referring to Medicaid cuts proposed in Trump’s budget and by pending legislation to repeal elements of the Affordable Care Act, including regulations mandating which basic aspects of health care insurers must cover. “That category cannot be underemphasized.”

Democratic legislators in recent weeks have highlighted the gap that would be left by a Medicaid cut. Data show that Medicaid-eligible patients in expansion states pay less in out-of-pocket costs for addiction treatment. Medicaid programs also account for roughly one-quarter of annual payments for buprenorphine, an opioid-based painkiller used in medication-assisted addiction treatment.

At Friday’s meeting, North Carolina Gov. Roy Cooper, a Democrat and a member of the opioid commission, also emphasized the importance of Medicaid in addressing the nation’s epidemic.

“We’re kidding ourselves if we don’t think that what is happening over in Congress regarding issues of health care matters to this issue,” he said, later citing Medicaid specifically. “If we make it harder and more expensive for people to get health care coverage, it’s going to make this crisis worse.”

There was consensus on at least some issues related to medical treatment during the session. Chief among them was that naloxone, an overdose-reversal drug, must be made widely available to communities and law enforcement agencies nationwide.

Cooper was also receptive to a point made by Dr. Kelly Clark of the American Society of Addiction Medicine, who maintained that despite Medicaid’s importance to addiction treatment it does not always spend its dollars efficiently, especially with regard to the “substantial” number of reimbursements issued for detoxification treatment.

“I can tell you that typically, the utilization of inpatient detoxification and the 28-day manualized rehabilitation is not evidence-based care,” she said. “We know that detoxification is not considered treatment by ACM for opioid addiction. We’re using a lot of expensive care in inpatient environments and not the ongoing care that we need to do for chronic brain disease treatment. It’s substantial.”