The Republican Healthcare Bill May Literally Cripple Americans and Worsen the Opioid Crisis, But Not For the Reasons You May Think

If you are one of the nearly 20% of people in the United States with a disability, your outcomes are likely going to get much worse under the Republican healthcare bill.

The Congressional Budget Office (CBO) just released sobering statistics suggesting 22 million American may lose health coverage over the next decade if the Republican healthcare bill is enacted. But buried in the dense legislative text is an estimate suggesting half of states will apply for waivers that allow insurance companies to design and sell plans that do not cover the 10 essential health benefits (EHBs) required under current law. Maternity care and mental health services have garnered most of the attention among the EHBs, but rehabilitation services such as physical, occupational, and speech therapy are also at risk.

Rehabilitation services are a critical part of recovery for many Americans after surgical procedures, traumatic injuries, or who have deficits from a stroke or similar disorder that need ongoing treatment. Rehabilitation services are also a key part of a shift towards more conservative, non-drug treatments to slow the growing rate of opioid addiction and abuse in the United States.

If adults don’t have access to insurance plans that include rehabilitation, recovery from injuries or surgery may be incomplete. A broken leg from a car accident may be surgical repaired, but improvements in flexibility and strength may be significantly limited without access to physical therapy — leaving a patient at risk for expensive injury, falls, or chronic pain. Being unable to walk, or walking with limp, may also limit employment choices, participation in recreational activities like skiing, or even something simple as playing with your children.

Many of these deficits that arise from a lack of rehabilitation access may be irreversible. Full recovery after a serious injury like a stroke occurs with aggressive rehabilitation, especially during the first 3–4 months. Without rehabilitation, stroke survivors may be unable to walk independently or require a lot of help from caregivers for basic tasks. Even basic tasks like eating may require the skills of a speech therapist to prevent choking or related complications. A stroke survivor may be forced to live in a nursing home instead of in their own home as a result.

Lacking access to physical therapy for conditions like low back pain, (among the most common and costly reasons adults seek healthcare) may also significantly increase costs for the healthcare system. Without physical therapy, adults are more likely to receive expensive imaging such as x-rays and MRIs, receive prescriptions for pain-killing drugs including opioids, and seek costly emergency room care. Taking away rehabilitation services also removes a major tool to combat the opioid crisis.

Allowing insurers to cut rehabilitation services is likely to significantly increase the number of adults living with a disability, and potentially hampers the fight against opioids.

The American people deserve better than a bill that may literally cripple half of them. To help meet the goals we have outlined for reducing disability burden in the United States, this bill must be summarily rejected.

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