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As Republican leadership in the U.S. Senate works to push through its health care proposal, York County officials are underlining the importance of Medicaid in their fight against the area’s ever-worsening opioid crisis.

Dr. Matthew Howie, executive director of the York Regional Opiate Collaborative, said he is deeply concerned with the Senate plan’s lack of funding for substance-abuse treatment and the chamber’s intent to slash Medicaid. 

He estimated Medicaid coverage pays for about 50 percent of all substance-abuse treatments in York County.

Many of those who seek treatment for addiction do not have health insurance until visiting a treatment center. After an evaluation by the center’s staff, many find out they are eligible for Medicaid and are enrolled in the program before treatment begins, Howie said.

The Senate’s Better Care Reconciliation Act of 2017 would result in 22 million more uninsured Americans over the next decade compared to current law, according to  estimates released Monday by the nonpartisan Congressional Budget Office.

Under the Senate’s plan, an expansion of Medicaid that began under "Obamacare" would remain until 2021, after which funding would be phased out over a three-year period.

The Better Care Reconciliation Act also allocates $2 billion in 2018 for state grants to add treatment and recovery services, far short of the $45 billion over 10 years requested by two Republican senators from states hit hard by the opioid epidemic.

More: Toomey noncommittal but upbeat about Senate health care bill

Howie said he believes there is a disconnect between the policies being formed in the nation’s capital and the reality of opioid addiction in areas such as York County.

Substance-abuse treatment should be a top priority in any health care bill coming out of Washington, D.C., especially at a time when millions of Americans are struggling with life-altering addictions, he said.

Lawmakers are not giving the opioid epidemic the necessary attention or funding because the nature of opioid addiction is “somewhat unpalatable” compared to other forms of epidemics, Howie said.

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“If we had an infectious outbreak that was costing this many lives consistently, I think that the (Centers for Disease Control and Prevention) would be under great pressure from the federal government to provide resources to try to fight that problem,” Howie said, noting there isn’t a “very public” or “unified” push from lawmakers to beat the epidemic.

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Public health issue: In a letter sent Monday to Sens. Pat Toomey and Bob Casey, Pennsylvania Attorney General Josh Shapiro said the Senate's plans to curtail access to substance-abuse treatment and place a cap on Medicaid spending "will prevent Pennsylvania from effectively combating the heroin crisis."

Opioid addiction is not only a law-enforcement issue — it is a public health issue, Shapiro said, calling on the senators to protect Pennsylvanians' access to health coverage and substance-abuse treatment.

"No level of law enforcement can solve this problem completely — expanding access to treatment is critical," Shapiro said. "The health care bill under consideration by the U.S. Senate will prevent us from effectively combating the heroin crisis because it eliminates guaranteed access to treatment for millions of Americans."

In a statement after the Congressional Budget Office released its scoring of the bill, Casey, a Democrat, called the GOP-led Senate's health care plan “obscene” and “unconscionable."

“Despite the deliberately misleading statements from the backers of this legislation, it is now clearer than ever that this proposed plan would decimate Medicaid, impose an age tax and hike premiums while risking job loss at rural hospitals,” Casey wrote. “And for those families struggling with the opioid crisis, this bill pulls the rug right out from under them.”

‘Commitment’ to treatment: York County Coroner Pam Gay, who co-founded the county’s heroin task force that has grown into the regional collaborative, said lawmakers need to have a “very intense commitment” to provide treatment to individuals with opioid and other addiction issues.

“I don’t believe cutting opioid addiction (funding) out of the picture or decreasing the help is a good move,” she said.

More: Amid GOP silence, Pa. health care groups worry over Senate bill

The opioid epidemic will continue to be a problem in York County for the foreseeable future, and cutting funding for people to get treatment could only make the problem worse, Gay said.

Of the 123 drug-overdose deaths in York County last year, 76 involved heroin, she said. 

Through the first six months of 2017, the coroner’s office has confirmed 63 drug-overdose deaths, including 54 confirmed heroin-related deaths, Gay said. Another nine deaths are suspected to have been caused by heroin.

Gay said the growing number of heroin deaths is a “lagging indicator” of drug usage in York County, with cheap heroin replacing expensive prescription drugs for many people.

More: Wolf lashes Senate health bill as even crueler than House’s

Prescription drugs accounted for the majority of drug deaths processed by the coroner’s office until 2014, when heroin began claiming more lives than any other drug, Gay said.

Without broad access to health insurance and health care, Gay said, she is “very worried” that people will turn to street drugs to self-medicate for legitimate medical reasons.

Gay also warned that, many times, non-opioid street drugs such as cocaine are laced with opioids, greatly increasing the risk of death when using them. 

Naloxone: As of June 15, police departments in York County had reversed 133 opioid overdoses using naloxone this year, Howie said. 

Unlike in some areas, funding for the opioid overdose-reversal drug will not be affected in York County. 

The York County District Attorney's Office provides law enforcement agencies with funding for naloxone, while other emergency responders are equipped with the overdose-reversal drug using funding from the York/Adams Drug & Alcohol Commission, Howie said.  

Still, Howie was frank about the potential, and very tangible, effects of the bill's deep cuts to Medicaid, calling it "a reasonable assumption" to believe more lives will be lost.

"If you make it more difficult to get people into care, what happens is more people will die," Howie said. 

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