The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
If individual insurance subsidies are allowed to expire at the end of the year, it won’t just harm the millions, including Ohioans, who use it to address conditions like high blood pressure and pneumonia. It will also rip thousands of people out of treatment for opioid-use disorder and increase overdose deaths, the CEO of a treatment company said on Tuesday.
Much of the federal government has been shut down since Oct. 1 as congressional Republicans resist calls to extend subsidies for insurance bought in marketplaces created by the Affordable Care Act. The subsidies are set to expire on Dec. 31, while open enrollment for next year begins in two weeks.
Amid the uncertainty, six states have already posted prices for insurance in the marketplaces next year. U.S. Sen. Raphael Warnock, D-Ga., posted on X an insurance quote received by one constituent, Axios reported. Coverage that cost $307 a month with the subsidy would cost $906 a month without it.
In Ohio, where about 583,000 get coverage on the exchanges, insurance companies have proposed increasing pricing by as much as 40%. It’s unclear whether those proposals include the possible loss of the subsidies.
The health nonprofit KFF estimates that on average, the cost of coverage will more than double for 24 million Americans if the subsidies are allowed to expire.
That won’t just result in many more uninsured Americans, said Cooper Zelnick, CEO of Groups. It will put treatment out of reach for hundreds of thousands of Americans suffering from opioid-use disorder.
The company has 20,000 patients in 12 states, including Ohio. Instead of billing insurers or Medicaid for services such as doctor visits or drug tests, Groups is paid based on outcomes as a consequence of its “wraparound” services.
That makes it the largest “value-based” provider of opioid treatment in the country, Zellnick said.
For many, those outcomes will be in jeopardy if the ACA insurance subsidies are allowed to expire, he said.
“We serve 1,500 people every week nationally who have coverage through the ACA exchanges who will no longer be able to afford insurance once the subsidies expire,” he said. “We believe a significant portion of those folks will wrongly not qualify for Medicaid and not be eligible for employer-sponsored insurance.”
For people in recovery to get coverage through the exchanges, they most likely have gotten things together enough to hold down one job or several. If coverage is no longer affordable, they will face the stress of no health coverage for themselves and their families at the same time they lose treatment for their addiction.
For every person who backslides into using, that means more kids growing up with the chaos and neglect of drug-addicted parents, more people languishing in jails and prisons, more uncompensated ER visits, and more absenteeism from work.
And then there are the people who simply won’t be here. The ACA health subsidies were implemented in 2021. They’re credited with helping bring down the rate of the uninsured in the United States to an all-time low of 8% in the first quarter of 2022, according to the U.S. Department of Health and Human Services.
Meanwhile, the number of overdose deaths plummeted from 111,451 in the 12 months ending in August 2023 to 73,690 over the period ending last April, according to the U.S. Centers for Disease Control and Prevention. That’s a merciful decline of more than one-third.
Zelnick said the drop is partly attributable to treatment financed through the ACA subsidies and through Medicaid. Letting the ACA subsidies expire will easily result in half a million opioid-addicted Americans losing coverage — and treatment, he said.
“We massively celebrated getting (overdose deaths) down 10%, 15%, 20%,” Zelnick said. “That’s 10,000 or 15,000 or 20,000 lives saved. If 500,000 people lose access to care, you could quite easily see a world where overdose deaths return to levels not seen since 2022, or 2023.”
Zelnick said that even more important than access to treatment, widespread losses of coverage will cause people in recovery to lose hope.
“Addiction treatment is a necessary-but-insufficient condition for success,” he said. “It’s not that treatment gives you a meaningful life. It’s that treatment gives you the opportunity to build a meaningful life. That involves work. That involves taking care of your family. That involves participating in your community.
“The person we’re talking about went through hell. Went through treatment. Got a job, and is supporting their family. If suddenly, they don’t get medication, they get sick and can’t go to work and they lose that job. Once you lose that job, you lose hope. And once you lose hope it seems futile to face one day at a time.”
