ACA Repeal Could Affect Addiction Treatment, Hospitals in Southeast Ohio

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ATHENS, Ohio — The implications of repealing the Affordable Care Act –which is also referred to as Obamacare– could go beyond thousands losing health insurance in southeast Ohio.

The ACA expanded the traditional idea of healthcare being there for an individual in case of a medical emergency to include proactive coverage for “essential health benefits.”

Daniel Skinner, Assistant Professor, Health Policy for Ohio University’s Heritage College of Osteopathic Medicine, said an essential health benefit at risk of ending with the ACA’s full repeal that would impact our region is coverage for mental health and addiction.

“We have this perfect storm of an opioid crisis and serious addiction problems and mental health problems in Ohio. And Medicaid is real foundation (in treatment) of that.”

The ACA permitted states to expand the requirements in which an individual was eligible for Medicaid.

Roughly 151,257 Ohioans suffering from substance use disorders and mental illness would lose Medicaid coverage with a full repeal, according to a study released by Harvard Medical School and New York University. Additionally, 69,255 Ohioans with the same conditions enrolled in individual plans from the federal marketplace would lose coverage.

“Some folks don’t envision how we’re going to be able adequately tackle that,” Skinner said. “Some of the governor’s budget proposals and some of the departments in the state government are already saying they need more resources to meet their mandate.”

Gov. John Kasich has been a supporter of the Medicaid expansion –with the promise of reform– since the prospect was introduced and took on his own party to get it implemented, as Skinner wrote in a piece published by the Journal of Health Politics, Policy and Law.

He recently credited the expansion as a major tool in battling the opioid epidemic.

“Thank God we expanded Medicaid because that Medicaid money is helping to rehab people,” he said in a story from the Statehouse News Bureau.

While no one replacement for the ACA has been presented by the GOP-controlled Congress, there are some who have proposed mental health and addiction resources remain intact.

Other essential health benefits such as maternity and preventative care have not been in similar discussions.

The repeal of the ACA without a replacement puts hospitals throughout southeast Ohio at risk of losing resources.

Policy Matters Ohio estimates Ohio hospitals could lose at total of $15 billion between 2018 and 2026 in a study published by the left-leaning think tank earlier this month.

By insuring more people through the ACA, hospitals could avoid going uncompensated for care provided to individuals who couldn’t afford it.

Because of the decrease in uncompensated care, organizations such as the American Hospital Association have urged President Trump to keep coverage in any ACA replacement.

While urban hospitals will stand a better chance of maintaining resources, rural areas are put at risk.

“Some of the community hospitals in the Appalachian areas are really in a much more precarious situation,” Skinner said.

Uncertainty surrounding the repeal and possible replacement of the ACA leaves other questions about how legislative action will affect healthcare in southeast Ohio.

The main question, perhaps is what will happen to those who received health insurance through the ACA, including the thousands added to Ohio’s Medicaid rolls.

“We had 700,000 people that gained insurance under the Medicaid expansion in addition to the 2.3, or so million people that were already on Medicaid in Ohio,” Skinner said. “That’s a lot of people. (Repeal) has significant consequences.”

A repeal of the ACA seems likely, as both the House and Senate passed measures to begin the process, along with President Trump issuing an executive order to “minimize the economic burden” of the ACA.