The Senate healthcare bill mentions the opioid crisis only once — but its effects could be devastating

to provide grants to states to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders."

Tennessee Sen. Lamar Alexander has argued, among others, that the appropriation is "by far the largest amount Congress has ever

It also doesn't account for the billions of dollars in funding for treatment and addiction services that could be lost due to other provisions of the BCRA, the Senate's bill.

The bill would have major effects on the opioid crisis — heres how:

Medicaid funding

The BCRA would phase out

The Congressional Budget Office estimated in March that the Medicaid rollback under the AHCA would result in approximately 14 million people coming off the rolls in the next decade. The Senate's rollback isn't much different.

The proposed phaseout of Medicaid expansion led Nevada Sen. Dean Heller, a Republican, to come out in opposition of the bill on Friday.

"You have to protect Medicaid expansion states. That's what I want. Make sure we're taken care of here in the state of Nevada," Heller said.

Republican Gov. Brian Sandoval expanded Medicaid in Nevada, which has the 15th-highest drug-overdose death rate in the US. Sandoval said on Friday that expansion has led to 210,000 Nevadans gaining coverage.

Essential Health Benefits

The BCRA, like the AHCA's MacArthur Amendment, would allow states to apply for permission to rescind some of the Affordable Care Act's regulations as long as states show how it provides "for alternative means of, and requirements for, increasing access to comprehensive coverage, reducing average premiums, and increasing enrollment.”

Unlike the AHCA, the Senate bill would not allow states to rescind regulations related to preexisting conditions, but it would allow states to waive some of the 10 essential health benefits that Obamacare mandated all health plans cover.

The CBO found in May that about one-third of the US population lives in states that would most likely make "moderate changes" to regulations under the AHCA, and about one-sixth lives in states that would make more extensive changes.

While the CBO has yet to release its analysis of the BCRA, it's likely that number will be comparable.

Christine Eibner, a health economist for the Rand Corporation, told Business Insider in May that while there was uncertainty about how states would change regulations, it was reasonable to think state legislators would be under a lot of pressure to cut back on EHBs if other states are able to show that doing so brings down premiums. If that happens, substance-abuse treatment is viewed as the benefit "most at risk" to be cut, Eibner said.

Who loses?

Approximately 1.84 million people in the US are receiving treatment for substance-use disorders or mental illnesses through Medicaid expansion or the ACA's individual insurance marketplace, according to research conducted by Richard Frank, a professor of health economics at Harvard Medical School, and Sherry Glied, a dean at New York University.

Those people would be at risk of losing the approximately $5.5 billion paid out for treatment through those two avenues of insurance.

A 2017 Health and Human Services report found that approximately 34% of individual-market insurance plans did not cover substance-abuse treatment before the Affordable Care Act. A similar number of plans could choose not to cover treatment if the requirement is waived.

An analysis conducted by Eibner and Christopher Whaley, a policy researcher at Rand, found that in places that waive substance-treatment benefits, the out-of-pocket cost for consumers who use those benefits could rise by $1,333 a year. For "high-need" consumers, like those who need an in-patient stay at a treatment facility, out-of-pocket costs could rise to $12,261 a year.

"This assumes people still continue to use treatment," Eibner said. "Some may not seek it at all if it becomes too expensive."