GOP Health Bill Could Cut Addiction Treatment, Former Drug Czar Says : Shots - Health News The director of National Drug Control Policy under President Obama, Michael Botticelli, says the proposed GOP health bill would decrease access to treatment in the middle of an opioid crisis.

Former Drug Czar Says GOP Health Bill Would Cut Access To Addiction Treatment

  • Download
  • <iframe src="https://www.npr.org/player/embed/520270916/520301676" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

ROBERT SIEGEL, HOST:

More reaction now to the Republican proposal on health care and specifically the impact it could have on addiction treatment. Michael Botticelli was President Obama's director of National Drug Control Policy. His office successfully pushed Congress to approve a billion dollars in new spending to fight the opioid epidemic, including expanding access to treatment. And Michael Botticelli joins us now. Welcome to the program.

MICHAEL BOTTICELLI: Thanks, Robert. It's good to be with you again.

SIEGEL: Members of Congress and Health and Human Services Secretary Tom Price have talked about trimming the essential health benefits guaranteed under the Affordable Care Act. Are you at all worried that they might cut mental health and substance abuse disorder services?

BOTTICELLI: That's a significant concern. You know, as you mentioned, the Affordable Care Act not only in increasing coverage but made addiction treatment and mental health coverage one of the 10 essential health benefits that we see. We have a long history to show where without those federal mandates, insurance companies, Medicaid programs really pay short shrift to addiction treatment as part of their benefit package.

SIEGEL: What do you say to people listening right now who say, you know, we're middle aged. Our children are off our insurance. We really don't use drugs. And we'd like to buy a policy that doesn't cover addiction services.

BOTTICELLI: I would say we all pay the price for untreated addictions. You know, certainly we know that it raises health care costs. We know that untreated addiction actually has other costs to it associated with crime and prison costs. So we're all paying the costs for this. And, you know, I have to say this, Robert, you know, given the magnitude this issue here, I'd be hard pressed to find a family that hasn't been impacted by addiction and particularly the opioid epidemic.

SIEGEL: About 30 percent of people who get Medicaid - through the expansion, at least - have a mental health or substance abuse disorder. What happens to them as states pull back on the expansion of Medicaid?

BOTTICELLI: Well, I think it's not hyperbolic to forecast that we're going to see dramatic increases in mortality associated with drug overdose deaths. I think we're likely to see a significant impact on our emergency departments. I would venture to say that we'll see dramatic increases in people in our jails and prisons. We know that untreated addiction has a nexus to homelessness. So the implications for this are profound not only in terms of the mortality that we've seen with drug overdoses...

SIEGEL: Yeah.

BOTTICELLI: ...But across our Health and Human Service and our public safety system.

SIEGEL: I want to ask you about what seemed to be a trend in public sentiment and in the sentiment of politicians and lawmakers over the past year or two, which was that it's time to treat opioid addiction in particular more as a medical issue than as a juridical problem.

Some cynics would say when the opioid addiction turned very white, America found a soft spot for addicts. Do you still have a sense that that sentiment is dominant in Washington? Or was that up until Election Day? And has it all gone away?

BOTTICELLI: I don't know if that kind of prevailing focus and emphasis is going to prevail. I hope it is. I think that, you know, both at the local law enforcement level and the state and national level, we've fostered that kind of approach to this problem. I would like to think that we've turned the corner and that we won't go back to kind of tough on crime, incarcerate people with addiction. But I think that that's a question that remains unanswered at this point.

SIEGEL: You served a Democratic president. We associate Democrats with belief in a robust federal government that addresses problems and at least coordinates around the country. Republicans now control both houses of Congress and the White House. And the party takes a very dim view of the federal government.

Explain what it is that someone from your vantage point at the White House dealing with drug policy, something that's mostly going to be dealt with by hospitals and policemen all across the United States, what's so vital in a federal role for that? Or can we think more in terms of federalism dealing with the problem?

BOTTICELLI: You know, we've needed federal mandates and federal controls on this issue. Addiction has been largely ignored by our health care system, by both Medicaid and private insurance. And I think without the provisions of the Affordable Care Act and federal parity laws, quite honestly that we would not have seen such a robust response in terms of increased access to treatment. So we need these protections. And people with addiction need these protections to ensure that they're going to have access to care.

SIEGEL: Michael Botticelli, who was director of National Drug Control policy under President Obama. Thanks for talking with us today.

BOTTICELLI: Thank you, Robert.

(SOUNDBITE OF RJD2 AND STS SONG, "MONSTERS UNDER MY BED"

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.