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ACA Repeal Seen Thwarting State Addiction Efforts

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at February 8, 2017

In the three years since the Affordable Care Act took effect, its federally funded expansion of Medicaid to low-income adults has become the states’ most powerful weapon in the battle against the nation’s worsening opioid epidemic.

Now, as Congress and President Donald Trump debate potential replacements for the law, governors, health care professionals and advocates for the poor are cautioning that any cut in federal funding for addiction treatment could reverse much of the progress states have made.

Since 2014, an estimated 1.6 million uninsured people with addictions have gained Medicaid coverage in the 31 states plus the District of Columbia that opted to expand the federal-state health care program under the ACA. Not all of the newly insured have sought help for their addictions, but treatment providers are reporting a surge in new patients since the law took effect.

In addition, the ACA has provided financial incentives for states to test new models for treatment that streamline care and improve outcomes.

Although a plan for replacing the federal health law has yet to be announced, House Republicans and Trump have proposed shifting Medicaid to a block grant, in which a capped amount of money would be allocated to each state to provide low-income health care services. By putting more of the cost burden on states, the shift is projected to save the federal government $1 trillion over 10 years.

But most states would be unable to come up with the extra money and would have to scale back efforts to get more people into treatment, said Lisa Clemans-Cope, a researcher with the Urban Institute, which analyzes health care policy.

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