GOP's Proposed Cuts To Medicaid Threaten Treatment For Opioid Addiction

Jun 11, 2017

Republicans in both the House and the Senate are considering big cuts to Medicaid. But those cuts endanger addiction treatment, which many people receive through the government health insurance program.

Charlene Yurgaitis is one of the people who's been helped. She's 35 and lives in Lancaster, Penn., and once supervised 17 people at an insurance company. But when some college students moved in next door about a decade ago, they became friends and she started doing oxycontin with them. Then she moved onto heroin and harder drugs.

Earlier this year, after about a decade of using, Yurgaitis finally had enough of that life and went into recovery. It's hard.

"I've been doing everything that I can possibly do to stop using," she says. "My normal thought is to just do it. Nobody will ever know."

To support her determination to stay sober, Yurgaitis gets a monthly shot of Vivitrol, also known as naltrexone.

"That stops me," she says.

The medication blocks receptors in her brain so she can't get high off opioids, but it also costs about $1,000 a dose. The monthly shots are paired with weekly therapy sessions, and visits with a recovery coach. Medicaid in Pennsylvania pays for all the treatment.

Having this health insurance is how she's managed to break her addiction over the past few months, Yurgaitis says.

"I would never be able to afford counseling," she says. "I would never be able to afford psych meds. I would never be able to afford the Vivitrol shot."

Yurgaitis is just one of more than 124,000 Pennsylvanians who depended on Medicaid to get help for their drug or alcohol addiction last year. The Republican health care bill that passed the U.S. House of Representatives in May and is now under consideration in the Senate would reduce spending on Medicaid by more than $800 billion across 10 years.

Yurgaitis' congressman, Rep. Lloyd Smucker, a Republican, voted for the GOP bill in the House; in the Senate, Pennsylvania Republican Pat Toomey has said he agrees that Medicaid should be cut.

Pennsylvania expanded Medicaid under the Affordable Care Act, and the state pays no more than 10 percent of the bills for the people who gained coverage under the expansion; federal funds contribute the other 90 percent. Toomey says states should have to pay a higher share.

"If it's not worth it to the state to buy this coverage at 43 cents on the dollar, [about what the state contributes to non-expansion Medicaid recipients] then how is it worth it to those very same taxpayers — who, at the end of the day, have to provide the funding for the federal program — why is it worth it to them to pay 90 cents on the dollar? It just doesn't make sense," Toomey says.

If federal Medicaid money gets cut, that would leave states to either fill in the financial gap, limit access to care or drop some people's coverage.

At a clinic in Harrisburg, Dr. Sarah Kawasaki says recovering from opioid addiction is so physically difficult that people need access to medication like naltrexone to help them break free.

If they can't get that medicine, she says, "I think that by necessity, they would probably have to go back to using heroin or any other medications they could find on the street to avoid getting sick. And I would worry about that."

Kawasaki is adamant — if funding is reduced, more people would die from overdoses, and Hepatitis C and HIV infections would rise because of dirty needles.

Yurgaitis, who is still in recovery, gets worked up just thinking about the potential cuts.

"Why are you trying to change something that's working? You know, that's what I don't understand," she says. "If I don't have those places to go to, I don't have anything else. I need to have that safe place to go to, and when I'm in my counseling session, that's my safe place. That's where I can unleash my demons, and clear my head out."

Yurgaitis hopes she'll be able to get treatment for years to come, so that at some point she can go back to work — perhaps helping other people recover from addiction.

This story is part of NPR's reporting partnership with WITF and Kaiser Health News.

Copyright 2017 WITF. To see more, visit WITF.

LULU GARCIA-NAVARRO, HOST:

One of the really big challenges in revamping health care is funding Medicaid, the federal program for low-income or needy people. House Republicans voted to cut it dramatically this spring. Behind closed doors, the Senate is looking at whether it should do the same. But advocates say one of Medicaid's benefits is getting people addiction treatment, especially in the middle of the current opioid crisis. Member station WITF's Ben Allen has this from Pennsylvania.

CHARLENE YURGAITIS: I saw you. How are you today?

BEN ALLEN, BYLINE: If you get her talking, Charlene Yurgaitis can be quick to smile. She shows me around her apartment in Lancaster, Pa.

YURGAITIS: Look at all my sneakers. And I keep them in boxes (laughter). I love sneakers and boots and flip-flops.

ALLEN: Yurgaitis, who is 35 years old, once supervised 17 people at an insurance company. Despite her lively personality, she says she never really felt accepted. And when some college students moved in next door about a decade ago, she started doing OxyContin before moving to heroin and harder drugs. She went into recovery earlier this year.

YURGAITIS: I've been doing everything that I can possibly do to stop using. My normal thought is to just do it. Nobody will ever know.

ALLEN: But Yurgaitis gets a monthly Vivitrol shot.

YURGAITIS: That stops me.

ALLEN: The medication blocks receptors in her brain so she can't get high off opioids but also costs about a thousand dollars a dose. That's paired with weekly therapy sessions and visits with a recovery coach. Medicaid pays for all of it.

YURGAITIS: Without the government helping me get where I'm at because, I mean, I would never be able to afford counseling. I would never be able to afford psych meds. I would never be able to afford the Vivitrol shot.

ALLEN: Yurgaitis is among the more than 124,000 Pennsylvanians who depended on Medicaid expansion to get help for their drug or alcohol addiction last year. The Republican health care bill that passed the House in May and is now under consideration by the Senate reduces spending for the program by more than $800 billion over 10 years.

Yurgaitis's representative in Lancaster County voted for the bill. And in the Senate, Pennsylvania Republican Pat Toomey agrees Medicaid should be cut. Under the Affordable Care Act's Medicaid expansion, states pay no more than 10 percent for those new people. Toomey says states should have to pay a higher share.

PAT TOOMEY: So if it's not worth it to the state to buy this coverage at 43 cents on the dollar, then how is it worth - those very same taxpayers who at the end of the day have to provide the funding for the federal program, why is it worth it to them to pay 90 cents on the collar? It just doesn't make sense.

ALLEN: If Congress cuts federal dollars to Medicaid, that would leave states to fill in the gap, limit access to care or drop people off coverage. At a clinic in Harrisburg, Dr. Sarah Kawasaki says recovering from opiate addiction is so physically difficult that people need access to medication to help. If they can't get it...

SARAH KAWASAKI: By necessity, they would probably have to go back to using heroin or any other medications they could find on the street to avoid getting sick. And I would worry about that.

ALLEN: Kawasaki he says flatly, if funding is reduced, more people would die from overdoses, and hepatitis C and HIV infections would rise because of dirty needles. In Lancaster, Charlene Yurgaitis gets worked up just thinking about the potential cuts.

YURGAITIS: Why are you trying to change something that's working? You know, that's what I don't understand. If I don't have those places to go to, I don't have anything else. And when I'm in my counseling session, that is my safe place.

ALLEN: Yurgaitis hopes she'll be able to get treatment for years to come so that at some point she can go back to work, perhaps helping other people recover from addiction. For NPR News, I'm Ben Allen in Harrisburg.

GARCIA-NAVARRO: This story is part of a reporting partnership with NPR, WITF and Kaiser Health News. Transcript provided by NPR, Copyright NPR.