Providing for Consideration of H.R. Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act; Providing for Consideration of H.R. Individuals in Medicaid Deserve Care That is Appropriate and Responsible in its Execution Act; and Providing for Consideration of H.R. Overdose Prevention and Patient Safety Act

Floor Speech

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Mr. RUIZ. Mr. Speaker, as an emergency medicine physician, I know firsthand what this devastating opioid crisis does to families, to individuals, to children, to parents. I have taken care of many who have come in overdosed, blue in the face, not breathing, many of which I have been resuscitated successfully and a few tragic losses along the way.

I know that many of them rely on being able to get the treatment whenever we are able to convince them to get treatment, but one of the biggest concerns that they have is: How much is this going to cost?

Many of them rely on Medicaid to be able to take advantage of some of the rehabilitation and the medication-assisted treatments that are offered to them. But, unfortunately, many of them, being uninsured, are unable to do so, and so then they repeat the cycle of abuse and misuse, and unfortunately, again, they present themselves overdosed in the emergency department.

I have an article here that sheds light on the importance of Medicaid. I bring Medicaid up because I feel like we are taking a few good steps forward in this opioid crisis, but we are missing the big picture when we have to defend Medicaid over and over again. Up to 45 percent of opioid-addicted patients rely on Medicaid to get their opioid rehab or misuse treatments to get back on steady footing.

There is an article here that I brought by Alana Sharp, et al., that was published in the May 2018 American Journal of Public Health, entitled: ``Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment.''

Basically, by using Medicaid enrollment and reimbursement data from 2011 to 2016 in all States, they evaluated prescribing patterns of opioids and the three FDA-approved medications used in treating opioid use disorders by using two statistical models--I won't bore you with which ones they used--and they found that although opioid prescribing for Medicaid enrollees increased overall, they observed no difference between expansion and nonexpansion. These are States that expanded Medicaid.

By contrast, per enrollee rates of buprenorphine and naltrexone prescribed increased more than 200 percent after States expanded eligibility, meaning that States that expanded Medicaid increased medication-assisted treatments for opioid misuse disorders by 200 percent. That means it works. That means when people get Medicaid, they use their Medicaid insurance to help get off of their dependency on opioids.

In the States that did not expand Medicaid, only less than 50 percent expansion of use.

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Mr. RUIZ. Mr. Speaker, the States that didn't expand their Medicaid enrollment, you saw that there continued to be a disparity of patients between those States and States that expanded their Medicaid in their ability to seek treatment.

So when we attempt to cut Medicaid in order to pay for the tax breaks we gave millionaires and billionaires, when we continue down that terrible path--or, I should say, government continues down that terrible path--to repeal the Medicaid expansion, which we must protect, then we are hurting patients. We are not providing them with tools that they need to get access to treatment.

The other big picture here is that mental health and emergency care payments are part of the essential health benefits. We have just passed experiences where we had to defend keeping these essential health benefits within the Affordable Care Act from being repealed.

We know that those patients who go to the emergency department at their last wits' end or that are suffering from overdose or severe side effects from misuse of the opioid medication, then they won't be covered if we repeal those essential health benefits.

And then, finally, having an addiction is a chronic condition. It is a mental health disorder with addiction characteristics, and this can be considered a preexisting illness.

We have States that are trying to repeal this through litigation. And when the government decides not to defend those protections for people with preexisting illnesses, they basically agree with those that want to repeal it and allow and facilitate the case to repeal those protections for preexisting illnesses. If that happens and if they are successful in doing so, that means that insurance companies can deny those who are addicted to opioids the insurance.

So I just want to keep the big picture in mind as we go forward that taking 2 steps forward doesn't justify taking 10 steps backwards.

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