President Donald Trump made a big promise on health care during his campaign—cheaper coverage for more people. Whether he delivers may sway many a voter and perhaps nowhere is this reflected more starkly than in his addressing the epidemic of opioid addiction.
Because the opioid epidemic has spread into the conservative havens of suburban and rural communities, many Republican voters, who may have traditionally cared little for addiction treatment coverage, now deem it essential.
Kraig Moss was one of them. In 2014, he lost his son to an opioid overdose. Two years later, on a campaign rally in Iowa, Trump answered his question and then talked to him some more while mingling with people after the rally.
“[He] told me he was going to work at making treatment centers more readily available,” Moss said. “From that point on, he had me.”
Moss followed Trump along the campaign trail, playing guitar and singing songs in support of the candidate. Sharing his story, he found many other Trump voters had a similar motivation—they believed Trump would be a Republican who will take care of the addicted.
A year later Republicans set about tackling another Trump campaign promise—replacing the Affordable Care Act (Obamacare).
Rising federal healthcare spending threatens to saddle future generations with a crushing tax burden. Thus, Obamacare’s replacement—the American Health Care Act—aimed to phase out Obama’s Medicaid expansion and cap federal Medicaid spending.
Here, however, Trump’s campaign promises to both expand treatment and replace Obamacare clashed, as states have been using the Medicaid dollars to expand addiction treatment.
“Thank God we expanded Medicaid because that Medicaid money is helping to rehab people,” Republican Ohio Governor John Kasich said in January, according to Ohio Public Radio.
Ohio suffered the third highest opioid overdose death rate in 2015, surpassed only by West Virginia and New Hampshire.
The opioid epidemic ultimately played a major role in sinking Obamacare’s replacement, according to James Morone, public policy professor and expert on the politics of health care at Brown University.
The conservative Freedom Caucus wanted to scrap Obamacare’s “essential health benefits,” a set of services that insurance companies must cover in the individual and small-group markets. The caucus blames the mandated benefits for driving up premiums, as people are forced to get insured for services they may not need, like maternity care.
But the essential benefits also cover addiction treatment.
Morone believes Republican congressmen from states hit hard by opioids didn’t want to let go of the mandated addiction treatment because insurance companies would then likely scrap the treatment from any affordable plans.
“It’s just too expensive,” he said.
Between detox, rehab, follow-up care, and medication, addiction treatment costs easily surpass $20,000 in the first year, and with a substantial risk of relapse.
To cure the 2.8 million Americans hooked on opioids, “you need a sort of national commitment,” Morone said. To a degree, Medicaid became a substitute for such a national commitment on the issue, and many Republicans likely realized their states can’t do without its dollars. Partly for this reason, the replacement bill got pulled before a House vote, he said.
For now, Republicans continue to work with Trump on a suitable replacement for Obamacare. If their next attempt is to succeed, it’s likely they'll need to convince Americans that dollars for addiction treatment, through Medicaid or otherwise, will continue to flow.
That’s certainly what Kraig Moss needs to hear, if Trump hopes to regain his trust.
