This article is part of the WCPO project Heroin: How Do We Respond?
A Republican health care bill has passed the U.S. House and now the Senate has produced a similar version. Both bills call for massive cuts to Medicaid, the health care program that covers some of the poorest and most vulnerable among us.
When Medicaid expanded, treatment became available for hundreds of thousands suffering from the disease of addiction.
What will happen if it is cut?
We asked WCPO's Heroin Advisory Group, a group of more than two dozen people affected by the drug problem, including doctors, professionals, parents and recovering addicts.
The group was virtually unanimous: Cutting Medicaid would cripple the progress that's been made in curbing the drug problem.
Margo Spence runs First Step Home, a Walnut Hills treatment program for addicted women and their children. Here's what she said:
“This is a major situation and we really have to rally to make sure Medicaid expansion continues or we’re going to take several steps back in this whole issue. This is the worst time ever because of the whole opioid pandemic.” -- Margo Spence
For many, Medicaid opened up the possibility of getting professional addiction treatment for the first time.
“A great deal of the women who were able to come in to our treatment services, came in because of the Medicaid expansion.” -- Margo Spence
In fact, in Ohio, 700,000 people were newly covered by Medicaid when the program grew. About a third of them had an addiction problem, state Medicaid director Barbara Sears told the WCPO Editorial Board.
Many who suffer from drug abuse will return to how they previously received medical care, Spence said.
"If Medicaid is rolled back, many of our clients will be using emergency care a lot more than they ever have in the past."
The Addiction Services Council provides counselors for heroin quick-response teams in Ohio and Kentucky, as well as other services for the addicted. Its development director, Kevin Richardson, said cutting Medicaid would have an immediate impact.
"We're looking at a 20 percent cut to our budget right off the bat, and it would probably get worse than that." -- Kevin Richardson, Addiction Services Council
Dr. Mike Kalfas is an expert in addiction through his Northern Kentucky medical practice. He is also straightforward about what would happen if Medicaid was scaled back:
“Pulling the rug out from under them is going to cause tons of relapses right off the bat. Over time, you’re going to see the effects of the worsening of the disease without treatment being available. You’re going to lose all the progress.” -- Dr. Mike Kalfas
Medicaid was a gateway for many to get addiction treatment the same way everyone else who suffers from a life-threatening problem does, by calling a doctor, Kalfas said.
“Before expansion, people were getting treatment through the courts. You get arrested, you can get treatment. With expansion, people were making a phone call and getting treatment.” -- Dr. Mike Kalfas
People with substance use disorders are notoriously difficult to treat. They often don’t follow doctors’ orders. They miss appointments. They often suffer from mental health issues as well as addiction.
Take away a source of payment -- Medicaid -- and doctors will be even less willing to see the addicted, he says.
“It’s been harder and harder and harder to get docs to treat addiction. But with Medicaid, some have stepped up and figure at least they will get paid something. That’s the first thing that will go – we’ll lose docs as willing providers.” -- Dr. Mike Kalfas
Medicaid not only made addiction treatment available, it made treatment for mental health available, as well as other basic medical care.
“My fear is that is going to go away,” said Steve Walkenhorst.
Walkenhorst is a WCPO advisory group member and longtime treatment advocate who is now with Transitions, Inc., a leading Northern Kentucky addiction treatment provider. He fears that losing Medicaid will mean that addicts will go back to treating themselves the best way they know – by abusing opiates and other drugs.
“People with addiction and mental issues have problems. Some also have chronic pain. So how will they deal with that? They’ll go to the park and buy whatever is being sold at the park. It’s going to go back to: how do we survive.” -- Steve Walkenhorst