In December, in rare and sweeping bipartisan action, Congress passed and President Obama signed the 21st Century Cures Act, legislation that included approximately $1 billion in critical financial support for states combating the opioid epidemic. However, researchers and public health advocates have since warned that the Act's provisions could be disproportionately overwhelmed, should the Affordable Care Act (ACA) be repealed without replacement. Opioid support gains the Act made possible would be vulnerable. Manatt Health's analysis confirms that an ACA repeal could leave many residents uninsured without access to care in states already experiencing the highest opioid death rates.

Using the latest data available from the Center for Disease Control's (CDC's) Multiple Cause of Death files, Manatt Health found that nine of the ten states with the highest opioid death rates in 2015 were at risk of losing coverage for their Medicaid-expansion populations (Figure 1), as well as for their large subsidized health exchange memberships. With health insurance coverage a lynchpin for access to evidence-based rehabilitation solutions such as medically assisted treatment, ACA repeal could leave patients without the necessary resources to fight addiction.

Over 33,000 people died in the United States from opioid-related drug overdoses in 2015, a 57% increase since 2010, and more than double the 2005 total (+122%). Ohio alone lost 2,700 residents to opioid overdoses; New York, 2,166; and California, 2,018. Nine other states lost more than a thousand lives. While West Virginia leads the nation in opioid-related deaths (34 per 100,000 residents), rates continue to increase in New Hampshire, Rhode Island, Ohio and Massachusetts, among dozens of other states, leaving policymakers across the country and the aisle acutely aware of the impact potential policy changes might have on states' abilities to address the epidemic.

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On January 11th, West Virginia Democratic Senator Joe Manchin stated that repealing the ACA without providing a replacement would "not only cause 184,000 West Virginians to lose their coverage," but would also result in "half of [the state's residents] in treatment [losing] their coverage that was made possible through the Affordable Care Act." Pennsylvania Republican Representative Charlie Dent concurred: "The impact of repealing the healthcare law without a pathway for reform or replacement on populations such as those suffering from substance abuse or mental health issues is one of the reasons I have urged…not to rush forward in initiating repeal efforts."

Manatt Health is currently advising several states with Medicaid behavioral health and substance abuse payment and delivery system reform agendas. For more information on Medicaid's role in battling the opioid epidemic, click here to download our recent issue brief, "Medicaid: States' Most Powerful Tool to Combat the Opioid Crisis."

Notes: Manatt Health analysis of Multiple Cause of Death File data using CDC developed opioid-related death specification.

Data Source(s): Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause of Death Files accessed via CDC Wonder Online Database.

Data Accessed: January 22, 2017