Source: | June 23rd, 2017
The much anticipated Senate-version of Obamacare’s repeal and replace legislation was revealed yesterday (June 22). Called the Better Care Reconciliation Act of 2017, it maintains many of the House provisions and the overall impact impact is similar. Both bills roll back many of the SUD coverage advances gained under the Affordable Care Act (ACA) and gives the states more flexibility to make state-level decisions.
A Senate vote is planned for the end of next week. Senate Majority Leader Mitch McConnell has been widely criticized about the closed-door process he used to draft the bill and rushing the vote without adequate input opportunities or review time. If it passes, it would need to be reconciled with the House’s bill before going to President Trump’s desk. Below is a general summary of ACA changes proposed in the House and Senate bills.
- Essential Health Benefits (EHBs): The ACA advanced access to SUD services by requiring all health plans sold on the Market place to provide MH and SUD coverage and comply with federal parity law. While there are subtle structural differences, both the House and Senate bills would allow states to opt out EHB requirements and define their own list of benefits. Health plans will likely want to reduce aspects of the current SUD benefit requirement and it will require dedicated state-level advocacy to maintain strong coverage requirements. Also affected is the prohibition against applying annual or lifetime caps to essential health benefit coverage. The proposed legislation allows States to opt out the ban.
- Medicaid: Currently Medicaid is an entitlement program with open-ended, matching federal funds for anyone who qualifies. The payment ratio in Texas is currently a 60 Fed / 40 state split. Both the House and Senate Bills restructure the Medicaid program into a block grant based on a fixed per capita amount. That means when the number of Texas Medicaid enrollees grows, Texas would not receive any Federal dollars to help with increased costs as it does now. The state budget will have to cover costs for enrollment growth which includes a 22% population growth estimate and long term care costs for the aging baby boomer population. Under the Senate bill the cuts to Medicaid will be deeper because per capita increases rise more slowly than in the House.
Another significant provision under the ACA is the eligibility expansion that allows states to cover childless adults making up to 138 percent of the federal poverty level under Medicaid with the Feds picking up a significant portion of the cost. Under both GOP reform bills, the Medicaid expansion would be phased out. Since Texas chose not to expand Medicaid, the impact of this reversal will not have the same impact as it will have for other states. The Senate bill did provide a more favorable block grant formula for those states that did not expand Medicaid.
- Pre-Existing Conditions: One of the more popular aspects of the ACA is the prohibition against increasing premiums or denying coverage based on preexisting conditions. The House and Senate both modify this provision. The House creates a new Patient and State Stability Fund allocating $130 billion over 10 years for high risk insurance pools and other programs to help insurers cover the costs of sick and expensive patients. The Senate maintains the insurance ban on increasing premiums or denying coverage based on a pre-existing condition, but permits states to allow an insurer to deny costs associated with some conditions. Under this option, states could limit covered SUD services depending on how the federal parity law is applied. The Senate also establishes a new Stability fund for $112 billion over 10 years which is aimed at reimbursing insurers who take big losses.
- Affordability: The federal subsidies that help people afford insurance would change in both the House and Senate versions. The ACA calculates subsidies based on income (400 percent of poverty or about $47,000 for an individual) and a mid-level coverage plan. The House bill would base subsidies mainly on age and phase out funding at an income of $75,000 for an individual. The Senate bill calculate subsidies based on a low-level plan and funding would no longer be available to those above 350 percent of the poverty level ($42,000 for an individual). Insurers would be able to charge older customers up to five times as much as they charge younger customers compared to 3X under ACA.
- Other Changes made in the House and Senate Repeal and Replace legislation:
- The individual and employer mandates are eliminated.
- Removes cost-sharing subsidies for insurers to help some customers cover deductibles and co-payments.
- States are given the option of requiring some Medicaid recipients to work or pursue job training.
- People can contribute more to pretax health savings accounts than under the ACA which is capped at $3,400 for individuals and $6,750 for families
- A provision of the ACA that allows young adults can to stay on their parents’ health insurance plan until they’re 26 years old is upheld.
- Taxes that were charged to raise more Addiction treatment was a $21 billion business in 2003, and is expected to double to $42 billion by 2020 — a growth rate some three times faster than inflation, according to federal health and census data.
Source: | June 9th, 2017
According to the World Drug Report 2016 from the U.N. Office on Drugs and Crime, heroin use has reached the highest level in 20 years in the U.S. and is the deadliest drug worldwide. UIC pharmacoeconomists led by Simon Pickard and Ruixuan Jiang created a cost-analytic model to determine how heroin impacts society using several variables: number of imprisoned heroin users and their crimes; treatment costs of heroin abuse; chronic infectious diseases contracted through heroin abuse (HIV, Hepatitis B and C, and tuberculosis), and cost of their treatments; cost of treating newborns with medical conditions associated with heroin; lost productivity at work; and heroin overdose deaths. On average, the societal cost per heroin user per year is $50,799. An estimated 1 million people are active heroin users in the United States, putting the total societal cost at approximately $51 billion, said Simon Pickard, professor of pharmacy systems, outcomes and policy. The cost per user is significantly higher than for patients suffering from other chronic illnesses, such as chronic obstructive pulmonary disease ($2,567 per patient in 2015 dollars, or $38.5 billion for 15 million patients) and diabetes ($11,148 per patient in 2015 dollars, or $248.59 billion for 22.3 million patients).
Source: | May 26th, 2017
Richard Baum, Acting Director of National Drug Control Policy, announced drug-related requests in the Trump Administration’s Fiscal Year 2018 Budget this week. The President’s Budget supports $27.8 billion in drug control efforts including prevention, treatment, and law enforcement.
- $12.1 billion for treatment and prevention efforts, and a $15.6 billion request for law enforcement, interdiction, and international initiatives.
- $10.8 billion in treatment funding, which is an increase of nearly 2% from annualized FY 2017 continuing resolution levels. This includes $500 million in State grants authorized in the 21st Century CURES Act to reduce opioid misuse and improve access to treatment, prevention, and recovery services.
- The budget request also secures our borders by investing $468.6 million in drug-related funding to support the President’s request for high-priority tactical infrastructure and border security technology to stem the flow of people, drugs, and other illicit material illegally crossing the border.
- A $246.5 million request for ONDCP’s High Intensity Drug Trafficking Areas (HIDTA) program and a $91.9 million request for its Drug-Free Communities Support program – both are the highest funding amounts ever requested.
Source: | May 12th, 2017
The Trump administration is moving to gut the office of the White House “drug czar,” according to a preliminary budget document and an email message the acting director has circulated to agency staff. The proposed $364 million cut would leave a budget of just $24 million and eliminates its two major grant programs: 1) high-intensity drug-trafficking area program, and 2) drug-free communities program. The document is a preliminary White House proposal for the drug czar’s office that was leaked to the Associated Press. The White Hose wouldn’t confirm the drug czar’s office is on the chopping block.
Source: | May 5th, 2017
It was a razor-thin victory: 217-213. With the exception of U.S. Rep. Will Hurd, R-Helotes, who voted against the plan, the Texas delegation voted along party lines. The vote occurred so swiftly that the nonpartisan Congressional Budget Office had yet to weigh in with cost predictions and estimates of the impact on how many people will lose their health coverage. The GOP’s proposal allows states to define which benefits all insurance plans must cover; such as mental health & substance abuse disorders which is currently required under Obamacare. According to several health care experts, it would likely drive down premiums, as plans with skimpier coverage would spring up in states which granted more flexibility. But it could drive up costs for out-of-pocket expenses and reliance on medically indigent state services.
- Cuts Medicaid Benefits and Shifts Costs to States. The AHCA would fundamentally change Medicaid financing from an open-ended federal and state matching formula into per capita based block grants. This change is estimated to save the federal government $882 billion over 10 years. With less federal funding, states would be forced to contribute more of their own dollars, or cut enrollee benefits and/or provider reimbursement.
- Greatly Weakens Mental Health and Addiction Parity. By removing the EHB requirement, many health plans may decide not to cover mental health and addiction services. Additionally, it weakens parity by allowing large employers to choose minimum benefit requirements from any state, skirting state mandates and resulting in decreased coverage for those in employer-sponsored plans as well.
- Ends Medicaid Expansion. The AHCA ends enhanced federal funding for the Affordable Care Act’s (ACA) Medicaid expansion. Without these funds, many states will likely choose to end their Medicaid expansion programs
- Allows Americans With Pre-existing Conditions to be Charged More. States could opt out the ACA prohibition against insurers charging sick patients more for coverage, so long as the state sets up a high-risk pool for people with pre-existing conditions. The latest amendment to the bill provides $8 billion over five years to help people with pre-existing conditions, but health care experts say this amount is completely inadequate.
- Reduces Subsidies on the Individual Market. The AHCA would repeal subsidies that help individuals purchase insurance on the individual market and replaces them with much less generous tax credits.
- Allows Older Americans to be Charged More. The AHCA allows insurers charge older customer up to five times as much as younger enrollees.
Source: | May 1st, 2017
One of the provisions of the 21st Century Cures Act was to create a new deputy level position at the Health and Human Services Department to direct mental health and substance use programs. Trump has named Dr. Elinore McCance-Katz. She is currently serving as the Chief Medical Officer for Rhode Island’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Her position must be approved by the Senate. McCance-Katz served two years under President Obama as the Chief Medical Officer at SAMHSA and prior to that she was the Medical Director of the Physicians’ Clinical Support System for Buprenorphine and the Prescribers’ Clinical Support System for Opioid Therapies at SAMHSA he was the Medical Director of the Physicians’ Clinical Support System for Buprenorphine and the Prescribers’ Clinical Support System for Opioid Therapies. She has worked in the field of addiction medicine for over 20 years as a clinician, teacher, and clinical researcher. Her specialty areas include pharmacotherapy for substance use disorders, clinical pharmacology of drugs of abuse, drug interactions, cocaine/alcohol/opioid medications development, and co-occurring HIV disease and addiction.
Source: | April 21st, 2017
The Texas Legislature is considering several bills
that would regulate powdered alcohol just like a bottle of whiskey, beer or wine. Technically it is legal in our state, but it’s not available for purchase anywhere in Texas. If the bills pass and regulations are put in place, sellers of powdered alcohol will begin to market in Texas. 30 states have already banned powdered alcohol completely. According to Texans Standing Tall, the lead advocate organization on this issue, Texas should follow other states and pass a ban instead of creating regulations because:
- The powder could be added to other alcoholic drinks, to increase potency, and it could also be snorted. Both can cause a rapid and dangerous rise in alcohol blood levels which increases the potential to harm oneself and others.
- Powdered alcohol is easy to conceal.
- It is a product that appeals to youth. Powered alcohol manufacturers have created flavors like cosmopolitan, margarita and lemon drop. These are exactly the kind of flavors that appeal to underage drinkers.
Public health and safety experts across the country have expressed concern over what they see as the potential risks of using powdered alcohol. In June 2016, the American Medical Association (AMA) announced its support for federal and state bans of powdered alcohol.
Source: | April 7th, 2017
As a candidate, Donald Trump promised states hit hard by opioid addiction that he’d solve the epidemic ravaging their communities. At the end of March President Trump took a step toward fulfilling that campaign promise by creating a new high-level commission on opioids. New Jersey Gov. Chris Christie has been tapped to lead the commission which also includes Attorney General Jeff Sessions, HHS Secretary Tom Price, VA Secretary David Shulkin, Defense Secretary James Mattis and as many as five other members. The composition is interesting because there are contrasting viewpoints among the appointed members. Gov Christie is a proponent of prevention and treatment and a public health approach to solving the opioid crisis, whereas Attorney General Sessions holds a more punitive view of drug use. The Commission has been charged with the tasks below. In 90 days, the commission will submit an interim report with its findings to President Trump. A final report is expected later this year. The commission will disband after issuing its final report.
- Review the funding and availability of treatment;
- Determine best practices for prevention and recovery;
- Evaluate federal programs and the U.S. health system to identify regulatory barriers or ineffective initiatives; and
- Recommend changes to federal criminal law or other processes.