Roughly Speaking Dan Rodricks: Commentary and conversation on life in Baltimore, Maryland and the USA

ACA repeal at odds with Trump response to opioid crisis, former drug czar says

The former White House drug czar questions the Trump administration’s commitment to dealing with the nation’s deadly opioid crisis while President Donald J. Trump continues to call for repeal of the Affordable Care Act.

The 2010 law defined addictions treatment as an “essential benefit” that must be covered through insurance policies sold in ACA marketplaces and through the expansion of Medicaid.

“You can’t simultaneously say, with any sort of credibility, that you’re pro-treatment — and that that’s going to be one of your prime responses — and put out call after call after call to repeal the Affordable Care Act,” says Michael Botticelli, who served as director of the Office of National Drug Control Policy in the Obama administration. “And President Trump has actually called for the repeal of the ACA without a replacement.”

Botticelli, my guest in the latest episode of the Roughly Speaking podcast, says failing to address the effect of ACA repeal was a “glaring omission” in the recommendation Monday that the Trump administration declare a national emergency to deal with the opioid crisis.

In making the recommendation, the President's Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey Gov. Chris Christie, estimated that 142 Americans die each day from causes related to the crisis. Nearly 2,100 people died last year in Maryland from drug and alcohol related overdoses, a 66 percent surge over 2015, the state's largest recorded annual increase.

The Christie commission recommended that the federal government increase funding for addictions treatment, but Botticelli says that’s already happening under the Medicaid expansion provisions of the ACA.

Ohio, West Virginia and Kentucky are among states that have seen the biggest increases in treatment. A study by the Center on Budget and Policy Priorities estimated that 2.8 million people with addictions, including 220,000 with opioid disorders, have found coverage for treatment under the ACA.

That’s why repealing the ACA would be counter to the recommendations of the commission and to Trump’s own expressed commitment to arresting the crisis, says Botticelli. There is not enough treatment for people who became addicted to heroin after becoming addicted to pain medication, Botticelli says, and still too many doctors prescribing potentially addictive medications to their patients.

“We are still prescribing at three times the level of 1999,” he says.

Visiting Baltimore Wednesday for the CityLab Baltimore, Botticelli now runs the Grayken Center for Addiction Medicine at Boston Medical Center. He is also now a distinguished policy scholar at the Johns Hopkins Bloomberg School of Public Health. You can hear our conversation in Episode 284 of Roughly Speaking, posting today.

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