HR-10254-119
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Madeleine Dean (D-PA)
What it does
This bill would require private health plans, Medicaid, and Medicare Advantage-adjacent Medicare Parts B and D to cover medications for opioid use disorder, overdose-reversal drugs, behavioral health treatment, and recovery support services (like peer counseling and transportation) without copayments, coinsurance, or deductibles. It also directs a Medicare innovation model testing eliminated cost-sharing in 15 selected states with high overdose rates and rural populations, and raises the federal Medicaid matching rate to 90% for medication-assisted treatment spending.
Who benefits
People with opioid use disorder and their families, including Medicare beneficiaries, Medicaid enrollees, and those with employer or individual-market insurance; addiction treatment providers, residential treatment facilities, and peer support/recovery service organizations; states selected for the Medicare demonstration and states with high Medicaid caseloads for medication-assisted treatment, which would receive an enhanced 90% federal match; public health systems and emergency responders who may see reduced overdose-related costs.
Who is hurt
Insurers, employer-sponsored group health plans, and pharmacy benefit managers, which would bear the cost of eliminated cost-sharing and may pass costs through premiums to all enrollees; states not selected for the 15-site Medicare demonstration, which would not see the enhanced testing benefits; federal and state budgets, which would absorb the enhanced 90% Medicaid match and lost cost-sharing revenue; plan sponsors and small employers facing new mandated coverage requirements without cost-sharing offsets.
Supporters argue
Supporters argue that cost-sharing is a documented barrier to opioid addiction treatment, with research showing even modest copayments cause patients to skip medication-assisted treatment that reduces overdose deaths. They contend that given tens of thousands of annual opioid overdose deaths, eliminating financial barriers to evidence-based treatment and recovery support is a targeted, cost-effective public health response that could reduce far larger downstream costs from emergency care, incarceration, and lost productivity.
Opponents argue
Opponents argue that eliminating all cost-sharing removes a mechanism that helps control overutilization and could raise premiums for all enrollees in a plan, spreading costs broadly to subsidize a narrower population. They contend that mandating first-dollar coverage for specific services without accompanying cost controls could increase overall health plan spending and that a permanent, untested 90% federal Medicaid match creates open-ended fiscal exposure for the federal government without a clear sunset or evaluation requirement.