Rochdale Village Health

WASHINGTON — The Senate leadership’s efforts to salvage the Republican health care bill have focused in part on adding $45 billion for states to spend on opioid addiction treatment.

That is a big pot of money. But addiction specialists said it was drastically short of what would be needed to make up for the legislation’s deep cuts to Medicaid, which has provided treatment for hundreds of thousands of people caught up in a national epidemic of opioid abuse.

The new money would most likely flow to states in the form of grants over 10 years, averaging out to $4.5 billion per year. With hundreds of people dying every week from overdoses of heroin, fentanyl and opioid painkillers, some specialists say a fixed amount of grant money is simply inadequate compared with the open-ended funding stream that Medicaid provides to treat all who qualify for the coverage.

“When it comes to other illnesses like breast cancer or heart disease, we’d never rely solely on grants for treatment — because we know that grants are not substitutes for health coverage,” said Linda Rosenberg, president and chief executive of the National Council for Behavioral Health, which represents treatment providers. “Addiction is no different.”

The Affordable Care Act vastly expanded access to addiction treatment by designating those services as “essential benefits.” That means they had to be covered through both an expansion of Medicaid to far more low-income adults and the marketplaces set up under the law for people to buy private plans. Both the House and Senate health bills would effectively end the expansion and cap federal Medicaid spending, resulting in the loss of coverage for millions of people, according to the Congressional Budget Office.

According to the National Household Survey on Drug Use and Health, there were roughly 1.35 million low-income Americans in 2015 with an opioid use disorder. Only 25 percent of those people get treated in a year, although the Affordable Care Act’s expansion of health insurance coverage has provided more resources for closing the treatment gap.

Richard G. Frank, a health economics professor at Harvard Medical School, has estimated that last year, people who enrolled in expanded Medicaid incurred about $4.5 billion in costs for mental health and addiction treatment. But in an updated analysis this month, Mr. Frank, who worked for the Obama administration during the rollout of the Affordable Care Act, calculated it would cost $14 billion in the first year and more than $183 billion over a decade to treat addiction and related illnesses in low-income people who would lose coverage under the Republican plan.

“Medicaid spending contracts and expands based on need as well as new treatment options,” Mr. Frank wrote in his analysis. “That means that funding is there for people and states when they need it the most. For example, the opioid epidemic will likely continue to morph and require different interventions of care should new synthetic drugs cause different health problems.”

Public health experts are concerned that grants aimed at treatment and recovery would not address a multitude of other physical health problems associated with addiction. One glaring example is hepatitis C, a blood-borne virus endemic among people who use needles to inject illicit drugs. Treatment is extremely expensive, but Medicaid has expanded access to it in many states. Many addicts also suffer from diabetes and other chronic conditions, or get endocarditis, a serious heart infection connected to intravenous drug use.

 

Election Day is Nov. 8. But the vast majority of the 50 states do not allow voters to register that day. Here’s a rundown of the deadlines to register by state.

The “mail” dates refer to the day by which an application must be postmarked. States that offer registration on Election Day often have special requirements. On a desktop computer, you may search for your state’s name with keyboard shortcuts: Ctrl F on a PC or Command F on a Mac.

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Although it’s been a long time, I vividly recall my reaction when I learned that I had been admitted to Amherst College: The admissions office must have made a terrible mistake.

I had graduated from a Long Island high school where most students didn’t go to college, so I was convinced that at Amherst I would be overmatched by my better-educated, more sophisticated classmates and sliced to ribbons by my brilliant professors. To my surprise, I fared well academically, but I never entirely got over the feeling of being an impostor. Only decades later, at a class reunion, did I discover that many of my peers had felt exactly the same way.

Regardless of their credentials, many freshmen doubt that they have the necessary brainpower or social adeptness to succeed in college. This fear of failing hits poor, minority and first-generation college students especially hard. If they flunk an exam, or a professor doesn’t call on them, their fears about whether they belong may well be confirmed. The cycle of doubt becomes self-reinforcing, and students are more likely to drop out.

The good news is that this dismal script can be rewritten. Several recent research projects show that, with the right nudge, students can acquire ways of thinking that helps them thrive.

In a large-scale experiment at an unnamed school I’ll call Flagship State, incoming freshmen read upperclassmen’s accounts of how they navigated the shoals of university life. The accounts explained that, while the upperclassmen initially felt snubbed by their classmates and intimidated by their professors, their lives started turning around when they reached out to their instructors and began to make friends.

“Part of me thought I had been accepted due to a stroke of luck, and that I would not measure up to the other students,” wrote one upperclassman. “Early on, I bombed a test. It was the worst grade I’d ever received, and I felt terrible and isolated. But then I found out that no one did well on that test. The professor was trying to set a high standard.”

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Earlier this year, the Food and Drug Administration approved a new weight-loss procedure in which a thin tube, implanted in the stomach, ejects food from the body before all the calories can be absorbed.

Some have called it “medically sanctioned bulimia,” and it is the latest in a desperate search for new ways to stem the rising tides of obesity and Type 2 diabetes. Roughly one-third of adult Americans are now obese; two-thirds are overweight; and diabetes afflicts some 29 million. Another 86 million Americans have a condition called pre-diabetes. None of the proposed solutions have made a dent in these epidemics.

Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.

It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.

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