The health care bill released by Senate Republicans on Thursday is stoking outrage among mental health and addiction groups for its proposed steep cuts to Medicaid, the government’s largest health insurance program. Medicaid is the single largest payer for mental health services in the United States and provides coverage for millions of Americans with mental health or substance abuse disorders.

The proposed change is especially painful for these organizations because they saw an expansion of mental health coverage under the Affordable Care Act. After it was enacted, an estimated 2.8 million Americans with substance use disorders and 1.3 million with serious mental illness gained health insurance coverage for the first time under Medicaid expansion. In some states, Medicaid programs cover more than 40% of prescriptions of buprenorphine, a drug that treats opioid addiction.

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Policymakers, researchers and health care experts examined the country’s opioid crisis and discussed ways to fight addiction in America on Wednesday in a series of panels put together by The Washington Post.

One panel, shown here, featured Dr. Leana Wen, Health Commissioner of Baltimore City. She spoke along with Dr. Andrew Kolodny, Co-Director of Opioid Policy Research at Brandeis University about how doctors and prescription providers are looking at new approaches to prevent, treat, and break patterns of addiction in communities across the country.

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The opioid epidemic is on the rise. Government data published June 20, which surveyed opioid-related hospital visits between 2005 and 2014, revealed a 64 percent uptick in inpatient care and a doubling of opioid-related emergency room visits.

Of the 30 states involved in the study, Maryland topped the list as the hardest hit by the epidemic. A state report released in June found that opioid-related deaths had nearly quadrupled since 2010.

“We see overdoses in all ethnic groups, in all Zip codes,” Leana Wen, Baltimore City’s health commissioner, told the Washington Post. The city is one of the hardest hit by the issue, seeing nearly two deaths a day from drug- and alcohol-related overdoses in 2016.

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After seven years of promising to repeal and replace the Affordable Care Act, Senate Republicans are now closer to achieving that goal than ever before. Thursday morning, they finally unveiled their secretly drafted healthcare bill. It is not, as some had hoped, a drastic departure from the House's version, which was passed last month. While being slightly less "mean," in that it provides more financial support to some lower-income groups, the Senate bill still lands punches to Obamacare in all the same places.

It still ends the healthcare mandate that every American be insured. It still gives power to the states to drop many of the essential benefits required by the ACA, including maternity care, emergency services, substance abuse, and mental healthcare treatments. It still ends the Medicaid expansion that helped 20 million people get insured (although one year later than the House proposed). And it places a cap on Medicaid, while simultaneously slashing about $840 billion from the entitlement program over the next 10 years to pay for enormous tax cuts for the wealthy. All of which adds up to very bad news for patients—but especially the 2.5 million Americans currently struggling with an opioid addiction.

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