President Trump spoke at the National Scout Jamboree in West Virginia on July 24, joining a long list of presidents who have spoken to the huge meeting of Boy Scouts, troop leaders and volunteers. The visit was not surprising, as West Virginia, in the center of Appalachia, is overwhelmingly Trump Country.

It is also at the center of the nation’s opioid epidemic, with a rate of 42 overdose deaths per 100,000, more than double the national average. Indeed, on Aug. 15, 2016, Huntington, home of Marshall University, experienced more than two dozen overdoses in a span of just four hours.

West Virginia is also a state that has been aggressive in taking advantage of opportunities offered by the federal government under the Affordable Care Act, including the ACA insurance marketplaces and the Medicaid expansion.

While about two-thirds of voters supported Trump in the election, support for expanding Medicaid has largely been bipartisan. At least until now.

With GOP repeal-and-replace efforts still very much up in the air, one thing has become clear: All proposals made public by congressional Republicans have significant, detrimental effects on West Virginia’s and America’s ability to combat the opioid epidemic.

An escalating problem

The opioid addiction crisis in America is growing worse. An analysis in June 2017 by The New York Times showed a 19 percent increase in drug overdose deaths from 2015 to 2016, and experts cited opioids as the likely reason for the increase.

More than 20 million Americans suffer from an addiction. Close to seven million of these addicts also have a mental illness. The Surgeon General’s office has estimated that the yearly losses in productivity, health care costs and criminal justice expenses for alcohol misuse and illicit drug abuse amount to US$442 billion.

In 2015, the most recent year for which figures are available from the Centers for Disease Control and Prevention (CDC), more than 52,000 Americans died from drug overdoses. More than 33,000 of these were due to opioids. This means that, compared to 1999, the number of opioid deaths nearly tripled.

This epidemic is not only killing people and ripping apart families. It also has created an enormous drain on America’s health and social systems.

Drug overdoses lead to more than five million emergency department visits per year.

In towns in West Virginia and many other states, school systems, fire and police departments, and city governments spend ever-growing funds on providing emergency overdose treatments such as Naloxone.

Indeed, Medicaid spending on the drug has increased by 90,000 percent in just five years.

A West Virginia program to support needy families with burial expenses has run out of funds for five years straight.

The epidemic has also created tremendous problems for child welfare system and schools, which have to deal with the drug-addicted parents and abandoned children.

Perhaps the saddest part of the story is the growing number of newborns delivered by addicted mothers, who have to undergo addiction treatment from the minute they are born.

How Obamacare helped

The ACA called for states to expand Medicaid coverage to more lower-income people. Not all states did this; the 19 who bucked expansion were Republican states.

But not all Republican states resisted expansion. West Virginia, desperate for help for its laid-off miners and for its thousands of people addicted to opioids, was one of the more than a dozen states that voted for the president and expanded Medicaid.

The expansion of Medicaid has been crucial in two ways. For one, providing insurance coverage for an additional 180,000 West Virginians has proven critical to getting many of them into treatment.

Moreover, the expansion population was subject to the ACA’s Essential Health Benefit provisions. This required states to make available substance abuse and mental health treatment to them.

Finally, the ACA’s Essential Health Benefit provisions required policies sold in the individual market to cover addiction and mental health services. It also eliminated annual and lifetime limits on these benefits.

Overall, more than 210,000 West Virginians with substance abuse or mental health problems gained coverage under the ACA.

Epidemic would escalate

While the exact nature of Republican repeal-and-replace efforts remains unclear at this moment, all proposals made public so far would pose enormous challenges for states like West Virginia to turn the tide on the devastating opioid epidemic.

One of the most essential tools in fighting the epidemic, the expansion of Medicaid, would be rolled back either immediately or over several years. Furthermore, the entire Medicaid program, the backbone of states’ efforts to provide treatment and services for opioid addiction treatment, would be further curtailed by per capita caps.

Moreover, all proposals would either outright eliminate or allow states to waive the crucial Essential Health Benefit provisions. These provisions require insurers to provide coverage for certain specified conditions, such as pregnancy, addiction treatment and emergency room care, that they might otherwise refuse to cover because of their costs.

Under certain proposals, lifetime and annual limits could also affect those covered by employer-provided insurance to lose access to crucial treatment options.

In its most recent iteration, Senate Republicans have added $45 billion over 10 years specifically to deal with the opioid crisis to bring on-board crucial moderates like Senators Shelley Moore Capito (Republican-West Virginia) and Robert Portman (Republican-Ohio).

However, as Ohio Gov. John Kasich stated, given the enormous size of the opioid problem, this amounts to “spitting in the ocean.” Medicaid alone spends more than $1 billion annually solely on medications for addiction treatments. This does not include costs to providers or treatment facilities.

Moving forward

Treating addiction is challenging and involves more than access to insurance coverage. However, evidence-based treatment, which includes replacement medications and counseling, has shown success in America’s fight against the epidemic ravaging many of its communities.

In my opinion, stemming the opioid epidemic requires a prolonged, multi-pronged approach.

It requires a hard look at how we prescribe painkillers. Health care providers like Kaiser Permanente have shown that success is possible.

It also requires taking a hard look at the role that pharmaceutical companies play.

It requires providing jobs and hope to rural America, which overwhelmingly voted for President Trump and his promises, and which disproportionately suffers from this epidemic.

Most definitely, it requires also providing medical treatment to individuals trying to overcome their additions. Unfortunately, so far, none of the GOP proposals have done that. GOP proposals do not include the means to do that.

Trump has long championed the people of West Virginia, but a visit to the Boy Scouts does little to alleviate the suffering in the heart of Appalachia.

Simon Haeder does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.