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What An Obamacare Repeal Would Mean for Addiction Treatment

The Affordable Care Act allocated $94 million to help clinics serving low-income Americans to help addicted patients. What happens now?
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Photo showing a dentist and assistant examining a patient

A Santa Barbara Neighborhood Clinics doctor and her assistant work on a patient.

Six months after the Santa Barbara Neighborhood Clinics began routinely asking all of their patients about drug use, staffers have identified more than 100 people with moderate-to-severe problems with street drugs, prescription painkillers, and alcohol. That’s about one out of every 37 people they screen. The clinics have ushered 59 of thosepatients into therapy, including three people who are now on medication-assisted treatment, a standard treatment for people with addictions to OxyContin, heroin, and other opioids.

“The opioid epidemic is one of the most pressing public health issues in the United States today,” Health and Human Services Secretary Sylvia Burwell said in a statement last year. At the time, her agency announced $94 million in grants, funded by the Affordable Care Act, for anti-addiction programs at low-income clinics, including the Santa Barbara Neighborhood Clinics. “Expanding access to medication-assisted treatment and integrating these services in health centers bolsters nationwide efforts to curb opioid misuse and abuse,” she said.

Just as these efforts are taking off, however, Republicans in Congress are seeking to repeal the Affordable Care Act. The party leadership supports repealing Obamacare before deciding on a replacement. And with Donald Trump’s new administration will come a new Health and Human Services secretary; Trump is hoping it will be surgeon and Republican congressman Tom Price, who opposes Obamacare.

The Santa Barbara Neighborhood Clinics — which offers preventative care regardless of people’s ability to pay — is one of more than 270 similar organizations that have received an Affordable Care Act grant to help them afford to screen and treat their patients for substance use disorders, especially opioid use disorders.

That help is much needed. Data suggests medication-assisted treatment is vastly underused. It’s thought that tens of millions of Americans need substance use disorder treatment, but don’t get it. The Obamacare grants for addiction services went to 45 states; Washington, D.C.; and Puerto Rico.

The $94 million has already been allocated and won’t be taken away, Health and Human Services spokesman Martin Kramer says. But after the grants expire in two years, it remains to be seen what will happen to programs like the Santa Barbara Neighborhood Clinics’.

“So far, the statements that have come out of Tom Price’s mouth are that substance use problems are a real problem and they want to dedicate some resources to this,” says Charles Fenzi, a doctor and Santa Barbara Neighborhood Clinics’ CEO. “We’re hoping that this will continue to be funded.” Kramer says he is still unsure whether funding would return to pre-ACA levels with a repeal.

Health and Human Services won’t start gathering 2016 data from their clinic grantees until next month, so we don’t yet know how effective these addiction grants have been. In Santa Barbara, at least, “it would appear that they’re doing what they need to do to fulfill their requirements of their grant,” Kramer says.

Still, Fenzi isn’t satisfied. “It’s going more slowly than I had hoped,” he says. He wanted to have put more people on medication-assisted treatment by now. In addition, of the 19 people that his staff have identified who seem to have severe problems with drugs or alcohol, fewer than half have been called by the mental-health coordinator. “Those are the folks we really need to get help for,” Fenzi says. His plan now? To relieve the coordinator of some unrelated duties, so she may make more calls, asking people to come in and get treated.