Why The House And Senate Health Care Bills Will Make The Opiate Epidemic Much Worse

The key to reducing physical pain is not just providing essential health benefits but also reducing economic inequality and uncertainty.

Co-authored by Michael Galinsky, the co-director of the documentary film, All the Rage (Saved by Sarno).

We are a nation in pain. The number of Americans suffering from chronic pain has quadrupled since 2001, with over 100 million affected today; that number is larger than the incidences of cancer, heart disease, and diabetes combined. Physical pain has also led to a massive increase in opiate addiction rates; painkiller use increased by 50 percent from 2006 to 2012, costing the US economy $635 billion – a 1,000 percent increase from 20 years earlier.  And this painkiller epidemic has turned deadly. The New York Times just reported that deaths from drug overdoses in 2016 experienced the largest annual jump ever recorded in the United States. While opiate addiction rates have exploded, there has been a growing sense of financial desperation as the widening income gap has eroded the well-being of the middle class. Almost 70 percent of households experienced either a reduction in earnings or an increase in their expenses after the 2008 financial crisis.

 Scientific studies and economic analyses show that the stress that comes from this economic insecurity is a driver of pain. For example, data shows that the incidence and costs of chronic pain track very closely with the widening wealth gap. Our own empirical studies have found a significant and positive relationship between unemployment and painkiller consumption, and our experiments have shown that economic insecurity literally causes physical pain. Furthermore, a significant body of evidence suggests that financial pain and physical pain are linked and mutually reinforcing.


Unfortunately, the House (AHCA) and Senate (BCRA) bills to repeal and replace the ACA (aka Obamacare) do nothing to improve this situation. In fact, it only makes the problem worse by increasing the already widening wealth and health gap that exists in the U.S.

According to the Congressional Budget Office (CBO), the House ACHA bill will leave 23 million people and the Senate BCRA bill 22 million uninsured by 2026, compared to the current health care law, which translates into greater economic insecurity – not less. The bill also reduces essential health benefits that all plans are currently required to cover, including mental health treatment.

These cuts to coverage and benefits will only make the opiate epidemic worse for two reasons. First, the cuts to Medicaid will directly reduce funding for people battling opiate addiction. For example, in West Virginia, one clinic owner estimated that 90 percent of her clients seeking treatment for addiction are on Medicaid. This can explain why National Public Radio had this headline after the bill was released, “GOP Senators From Opioid-Ravaged States Uneasy About Health Care Bill”

But there is a second reason why these bills will exacerbate the opiate crisis: The inability to pay for health care costs plays a huge role in generating economic insecurity. Furthermore, people facing the greatest economic insecurity today are also those most likely to be harmed by the bill, which slashes huge sums from Medicaid.

Any new health care bill needs to address the links between economic insecurity, physical pain, and opiate addiction. The ideal health care bill would be portable, cover essential health benefits, and cap out-of-pocket expenses. Portability is crucial because employee-based insurance plans reduce entrepreneurship by tethering people to their company health care plan. Covering essential health benefits are necessary to offer routine care and prevent easily cured diseases. And capping out out-of-pocket expenses would dramatically reduce economic insecurity. This bill would also allot physicians sufficient time to understand the personal circumstances of their patients. As our own research and experiments show, helping people feel more in control of their lives can reduce the incidence of physical pain.

The right health plan will decrease an epidemic that is taking lives and crippling our economy. The current bills in the House and Senate, in contrast, fail this test. Without these major improvements, the AHCA will literally be a pain in the neck.