S-2072-119
Read twice and referred to the Committee on Finance.
Sponsored by Richard Blumenthal (D-CT)
What it does
The bill would require group health plans and insurers offering group or individual coverage to cover opioid use disorder drugs, overdose reversal drugs, behavioral health services, and recovery support services (such as peer counseling and transportation) with no cost-sharing, for plan years starting on or after January 1, 2027. It would direct the Medicare innovation center to run a model in 15 states, starting within six months of enactment, that eliminates Medicare Part B and D coinsurance, copayments, and deductibles for these items. It would also set the federal Medicaid match at 90 percent for medication-assisted treatment in the 50 states and D.C., and let states choose to add recovery support services to that treatment.
Who benefits
People with opioid use disorder who have private, employer, Medicare, or Medicaid coverage and would pay less out of pocket. Medicare beneficiaries in the 15 selected states, which must have many beneficiaries, high opioid overdose death rates, and large rural areas. State Medicaid programs that would receive a 90 percent federal match. Treatment providers, residential facilities, and recovery support organizations that may see more patients. Families of people in treatment.
Who is hurt
Employers with group health plans and insurers, who would cover these services without cost-sharing and may pass costs on through higher premiums. Federal taxpayers, since Medicare cost-sharing would be eliminated in the model states and the Medicaid match would rise to 90 percent. Medicare beneficiaries and residents of states not selected for the model, who would not get the Medicare benefit. Plan enrollees generally, if premiums rise across the pool. The federal government and states would bear administrative costs of the model.
Supporters argue
Supporters argue that cost-sharing is a barrier to evidence-based treatment such as medication-assisted treatment, and that removing it could increase treatment uptake and reduce overdose deaths. They contend that a time-limited, 15-state Medicare model is a measured way to test the approach, and that the enhanced Medicaid match helps states fund treatment while the overdose crisis continues.
Opponents argue
Opponents argue that mandating zero cost-sharing raises costs for employers, insurers, and taxpayers, and that those costs could appear as higher premiums for all enrollees. They contend the 90 percent Medicaid match and the Medicare model add federal spending without a demonstrated offset, and that a mandate with no cost-sharing leaves little room for plans to manage utilization.
Constitutional context
Congress would regulate insurance and employer plans under the Commerce Clause and tax and spend powers, as in NFIB v. Sebelius (2012), which upheld broad insurance regulation of existing activity. The Medicaid match is a funding increase and a state option for recovery services, so the Sebelius coercion limit on funding conditions seems unlikely to be implicated.
Checks and balances
Congress sets the coverage mandate and funding; the executive branch (CMS, the Departments of Labor, HHS, and Treasury) implements and selects the model states, and courts can review implementation.
Historical precedent
The ACA required coverage of preventive services without cost-sharing, and the SUPPORT Act of 2018 expanded Medicare and Medicaid coverage of opioid use disorder treatment.