President Trump’s declaration of opioids as a public health emergency left jurisdictions across the country – including New York City, Los Angeles and Chicago, the cities and county we serve as health commissioners and director – scrambling to understand the actual impact that this legal action will have on our response to an alarming increase in drug overdose deaths. In our cities, 2,650 people died last year of a drug overdose, the largest number on record.
Given the public health emergency designation, answers to three basic questions will determine the significance of this action: How much funding for public health responses will states and cities actually be able to access to support a long-term response to this deadly epidemic; how those dollars can be used; and for how long new funds will be available.
To be clear, the President’s declaration of a public health emergency is an overdue recognition of the reality of the opioid epidemic in our cities and across the country. But it is definitely short from the much anticipated declaration of national emergency the President had promised, and without much-needed resources to expand effective interventions it will be largely symbolic.
The President’s commission on combating the opioid epidemic has reportedly finalized a 53-page recommendation document that will guide the implementation of this plan. While we wait for official details, we remain very concerned about the future of another crucial piece in our nation’s response to the alarming increase in overdose deaths: Medicaid – perhaps the most significant source of funds to treat opioid addiction.
In his speech last week, the President prompted Americans to know that the federal government “is aggressively fighting the opioid epidemic on all fronts.” As we assess the President’s announcement, we must remember that the true test of how seriously our country takes the opioid crisis will come down to our commitment to preserve our public insurance program for low-income people.
Ironically, just as President Trump hypes his announcement, at the same time – in a position drastically at odds with a plan to combat the opioid crisis – he is still pressuring Congress to make extensive cuts to Medicaid. His tax plan, now being debated by Congress, includes a substantial $1 trillion cut to the program by 2026. His Administration has also overtly advocated for including cuts to Medicaid in a new health care bill. While not in the headlines at the moment, the legislative push for repealing the Affordable Care Act is far from over. In his announcement of an executive order on health care two weeks ago, the President promised a new bill “in the coming months” that will have broad support from the GOP; if the two failed health care bills are any indication of what is to come, an ACA repeal will slash Medicaid by hundreds of billions of dollars.
If the President succeeds at dismantling Medicaid, the emergency declaration will do little to reverse America’s upward trend of overdose deaths.
Medicaid has given millions of Americans access to substance use disorder treatment, providing health care coverage to some 3 in 10 people with opioid addiction in 2015. The program covers addiction treatment services, including reimbursement for the life-saving medications buprenorphine, methadone and naloxone. It also helps fund other approaches that we know work – including raising awareness and reducing stigma about drug use and distributing naloxone, an emergency medication to reverse overdose. Currently, over half of the states have increased access for Medicaid enrollees to naloxone. This is not just about the urban centers we serve; a cut to Medicaid is going to be felt in other parts of the country where the epidemic is acute, from New Mexico to New Hampshire.
For a full and honest response to the opioid crisis, we urge President Trump to support the bipartisan health care bill currently before the Senate, which would not change the number of people with Medicaid or private health insurance coverage. The President’s support of this bill, along with the emergency declaration, will protect access to health insurance for people with drug addiction and at risk of an overdose. We cannot risk their lives. Our leaders in Washington must continue to give Americans the resources they need to get effective care to prevent overdose and treat addiction. Without a true commitment to reverse this deadly trend, these entirely preventable deaths will continue to soar.
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