WASHINGTON - America's drugs crisis with millions addicted to opioids, including heroin, is likely to deepen if the Republican Party succeeds in passing funding cuts in its controversial health care Bill, experts say.
Increasing numbers of Americans are addicted to opioid prescription pain killers. Many then shift to heroin. In 2015 there were more than 52,000 drug overdose deaths in the US - more than in any other year on record, and more than in any other country.
"It is a staggering epidemic. I don't think it's levelling off, it seems to be accelerating," Bob Fowler, executive director of the Milestone Foundation, which provides detoxification programmes to addicts in Maine, told The Straits Times.
Federally funded Medicaid enables a significant number of opioid addicts to pay for medical care, substitution therapy and rehabilitation.
But the planned spending cuts under the Republican's Better Care Reconciliation Act (BCRA) would cut US$772 billion (S$1.07 trillion) from the Medicaid program over the next decade.
Overall, cuts would by 2026 leave an estimated 49 million people uninsured, compared with 28 million who would lack insurance that year under current law, the Congressional Budget Office said on June 26.
Studies indicate that up to 80 per cent of global opioid supply is consumed in the US -- painkillers readily supplied by pharmaceutical companies and widely prescribed by doctors.
A study published in the October 2016 issue of the journal Medical Care, estimated that the prescription opioid epidemic costs the US economy US$78.5 billion annually.
Treatment funded by Medicaid saves lives and helps addicts kick their drug habit, experts say.
"The difference in terms of access to treatment for someone who has Medicaid versus not is night and day," Mr Fowler said.
In Pennsylvania, Medicaid pays for at least half the people accessing treatment for substance abuse disorders," Dr Sarah Kawasaki, Director of Addiction Services at the Pennsylvania Psychiatric Institute.
"This epidemic needs a public health approach to get the most people possible access to treatment, and a part of that approach is insurance. Without health insurance, we're done," she told The Straits Times.
Voting on the BCRA has been pushed to the week of July 11 because it was unlikely to get the required support in the Senate in its current form.
Almost wherever they go, Republican senators have been hounded by protesters in recent days. Republicans running states hardest hit by opioids - like Ohio and Maine - are balking at supporting the Bill.
"It could theoretically make the opioid crisis worse," said Evan Siegfried, a Republican strategist and commentator. "The Bill is an all-out assault on Medicaid. People are very worried, they feel directly impacted in a tangible way."
This is the party's second attempt to replace the Affordable Care Act commonly known as Obamacare, which expanded health insurance coverage to millions but has seen premiums rise and businesses complain about having to shoulder the costs for employees. The scheme is failing, Republicans insist.
One of the main goals of Congressional Republicans is to reduce health care costs for the federal government.
But Republicans are caught between their own ideology, Mr Trump's promises of better health care; and the realities of the electorate, which they will face in mid-term elections in November 2018.
"Some see it as damned if they do, damned if they don't" Mr Siegfried said.
"We've been telling our base for seven years we're going to repeal and replace Obamacare; if we fail to do that the base will not be happy and that is a major problem because why would voters even show up for the mid-term election if we don't do what we promised when we had a majority," he said.