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What Medicaid Cuts Could Mean For The Opioid Epidemic


We wanted to take a closer look at one particular issue with the Senate's new health care bill that has been raised by a number of skeptics and critics including President Obama in a Facebook post on Thursday. That's the question of how the Senate GOP bill will affect efforts to combat a growing public health crisis - opioid addiction.

According to an estimate from The New York Times, drug overdoses are now the leading cause of death for Americans under 50. The Senate bill proposes $2 billion for treatment and recovery services through 2018 to offset cuts to Medicaid funding at the state level. Democrats and even some Republican lawmakers say that's tens of billions of dollars too little to adequately address this crisis.

To hear more about this, we called Lynn Cooper. She is director of the drug and alcohol division at Pennsylvania's Rehabilitation and Community Providers Association that oversees some 170 substance abuse related health care facilities around the state of Pennsylvania. And she's with us now from her home in Pittsburgh. Lynn Cooper, thank you so much for speaking with us.

LYNN COOPER: Thank you. It is indeed my pleasure.

MARTIN: So I call this a crisis. Is it a crisis?

COOPER: I think it's way past crisis. It goes beyond just a drug epidemic. It is a death epidemic all over the country. The loss of Medicaid expansion will be like the bottom dropping out for thousands of Pennsylvania citizens and their families.

MARTIN: So let's - walk me through this. So how many people would you say are getting treatment in your network now? And have you seen a big increase in recent years? Can you just give us some numbers to help us see the scope of the thing?

COOPER: Absolutely. According to the Pennsylvania Department of Human Services, we're talking an additional 855,000 citizens have been newly enrolled in medical assistance. And at least 100,000 of those are folks struggling with substance use disorder.

MARTIN: You said that about 850,000 people have been newly enrolled. Is that because of the Affordable Care Act?

COOPER: Oh, absolutely. That's the Affordable Care Act. That's because of Medicaid expansion.

MARTIN: I think you were telling us earlier that Medicaid overwhelmingly pays for. That...


MARTIN: ...Is the major source of funding for substance abuse treatment in Pennsylvania. Why is that?

COOPER: Basically, in the state of Pennsylvania right now, we have Health Choices, which is a managed care of Medicaid. And it has been extremely effective in our state. But the problem we had before Medicaid expansion is that many people were not eligible despite the fact that they were very poor and unemployed.

Before Medicaid expansion, our counties were running out of money. Now, today, this Medicaid expansion has absolutely stopped that. And a lot of the people that the county funds were paying for are now being covered by Medicaid expansion. But I got to be honest with you. Even with Medicaid expansion, we still have people that are not able to access treatment due to the lack of funding.

And when we heard talk in Washington about adding $2 billion to this problem, I can tell you right now, $2 billion wouldn't even be enough for the state of Pennsylvania. Eighty-five to 90 percent of all of the clients that we serve are Medicaid or program funded. And this would be devastating to our treatment programs.

MARTIN: So if the Senate bill passes in its current form, it would cap Medicaid. And that would require the states to make choices about who gets the funding. What is your worst case scenario?

COOPER: Worst case scenario. The state of Pennsylvania already has a $3 billion deficit. And if we do end up having to choose between programs, if our leaders are forced to do that, it's unfortunate. But very often, drug and alcohol ends up the last on the totem pole. When you're competing for funding, it's hard. I mean, someone who needs kidney dialysis or someone who is severely intellectually disabled and then you have the drug addict.

The stigma that exists for drug addiction right now remains terrible. People have a hard time understanding that there's a ripple effect. And part of it is an emotional and family effect. And the other part is a financial and a fiscal effect because we're going to be increasing costs in children and youth.

Eighty percent of children that are removed from their home are removed due to a substance use disorder. Now we have displaced children that need foster care. We're going to be increasing costs in jails and prisons. Our jails right now across the country are full of people who need drug and alcohol treatment. The opioid crisis affects everybody of all walks in life.

MARTIN: That's Lynn Cooper. She's director of the drug and alcohol division at Pennsylvania's Rehabilitation and Community Providers Association. She was kind enough to join us from her home office in Pittsburgh. Lynn Cooper, thank you so much for speaking with us.

COOPER: Thank you very much.

(SOUNDBITE OF SHARON VAN ETTEN'S "JUST LIKE BLOOD") Transcript provided by NPR, Copyright NPR.