Health Care Reform: As Overdose Deaths Soar, GOP Plan Would Cut Treatment

Editor's Note: Senate GOP leaders have promised to keep working on legislation to reform the nation's health care laws, pushing provisions that would have profound effects on millions of Americans. While the number of deaths from opioid overdoses approaches 100 every day, the Senate plan could effectively end treatment services for many of the 2.5 million Americans struggling with opioid addiction.

Patch editor Tom Davis explores the impact the legislation could have on efforts to slow the opioid-abuse epidemic.

Pamela didn't really have a problem with drugs. Then one of her children died about a decade ago. That's what put her over the edge.

About seven months ago, she showed up at the Integrity House in Newark loaded on PCP and opiates. That's when she finally got the care she needs, coverage for her treatment paid in part through the Medicaid expansion provided by Obamacare

"I had to get better for myself," said Pamela G., who asked that her full name not be published.

As the number of deaths from opioid overdoses in the country approaches 100 each day, an epidemic that shows not signs of slowing, Senate GOP leaders are pushing a health care plan to replace current law and effectively end treatment for many of the 2.5 million Americans struggling with opioid addiction.

The father of Pamela's children is one of those people. He still uses. He can't do what she did, for whatever reason, to save himself. For now, to Pamela, it's like he's dead, too.

She's got a $2-an-hour waitress job that's low-paid because she's supposed to get tips to make up the difference. The kicker is that she hardly gets any tips.

"I can't even afford my rent," she said..

Her children are staying with family, and she gets to see them once a week. But they're in the Cherry Hill area, while she's mostly in Newark at the Integrity House working on getting herself better.

All she has left is her recovery. All she tries to do is focus on herself. so she can eventually turn back to her old life, but deal with it better than she did before.

Only now, it's all looking a little shaky.

Pamela is one of millions of Americans who depend on Obamacare, which expanded Medicaid coverage to provide insurance coverage for more of the poorest of Americans.

The Congressional Budget Office has estimated that 23 million people could lose their insurance with a plan put forward by the Republican House of Representatives. The Senate version of the Affordable Health Care Act would leave 22 million without it. Without the benefit of Obamacare and Medicaid, Pamela may never be able pay for her recovery over the long haul.

Under the Senate version of the bill, it could get even worse. The Senate plan actually deepens long-term Medicaid cuts, keeping funding largely in place until 2020, but using caps and a different, stingier consumer inflationary index that could ultimately provide less money to her.

Without Medicaid, she'd have to pay out of pocket. On a $2 salary with few tips, however, it's not likely.

"That's something that's bothering me," she said. "It's a little scary."

Robert J. Budsock, president and CEO of Integrity House, one of the state's largest nonprofit providers of addiction treatment that's taking care of Pamela, had another word to describe what could happen to Pamela - and the fact that many people like her earn such little money to stay afloat.

"It's almost criminal," said Budsock.

Pamela started saving herself when she saw a 1-800 number to get help. Even though she had both PCP and opiates in her system, she had the presence of mind to do something.

Pamela was directed to the Integrity House, where she she went through treatment and now lives in "Women's Supportive Housing" where tenants are required to pay rent on a monthly basis, based on their income.

That part of Pamela's life appears doesn't depend on Medicaid. But to stay there, Pamela has to be sober. At the same, she's receiving outpatient treatment, and Medicaid is billed for for this service.

Budsock said Integrity House served 3,000 people in 2016. Most of them, he said, would be left out in the cold if Congress and President Trump follow through on the American Health Care Act, which recently passed the House of Representatives by 4 votes. A vote on the Senate version of the bill that remains pending would mean similar cuts.

For Pamela and many like her, Budsock said, "there would be no source to receive her services."

"It's a little scary to think about Medicaid being phased out," he said. "They go on to Medicaid to put their lives back to together and then to become regular taxpayers."

Pamela doesn't want to turn back. She's seen a lot of things in her time. Without treatment, she could relapse and possibly overdose. For a long time, that was what she feared about her life the most.

She didn't even start doing the hard drugs until she was 24. For a time, she worked in the finance department of a furniture store, and it was a good paying job that kept a roof over her head, and helped keep the family together.

But when Pamela started using, all that drifted away. Her employers told her to get help. They never told her she lost her job when she went to rehab. But she's not so sure she'd get it back if she ever returns to South Jersey.

"They weren't too happy when I left because they had to lose an employee," she said.

Now's she's 32. After almost a decade of this, the past seven months have finally been different.

Since she's received treatment with Integrity House, Pamela's managed to find structure. Initially, she was in the long-term residential program that includes inpatient treatment.

She wasn't able to hold a job while she was there because Pamela was focused on her treatment. Eventually, she was able to graduate to out-patient care and move to supportive housing, and then get a job.

Pamela takes a bus to get to work, but the outpatient treatment is only three doors away.

She's added things to her routine in recent weeks, including going to see her kids a 3-year-old son and 7-year-old daughter once a week. "They're two buses and two trains away," she said.

Pamela said her 7-year-old gets what she does, and she's supportive. The 3-year-old? "He just thinks I'm on vacation," she said.

She's thought about moving back home permanenty, but she's decided to stay mostly in Newark for now. She's not sure how long that will be, but she has no deadline. "I want to get this right," she said. "That's why I'm still doing this."

Medicaid has given her that opportunity, she says. That's the part that has kept her alive.

"This wasn't an easy process, but you have to want it," she said. "There are people in the program who don't want it. But we always say to those people, 'One day at a time.' "

Patch file photo