Many people are worried about the possible loss of the Affordable Care Act (ACA) and Medicaid expansion, about parity and access to treatment. But lobbyist Andrew Kessler says the threats to any Medicaid, and even to the liberty to seek treatment instead of being put in jail for substance use, make it essential to take a bigger view. “Of course we want to work with the new administration,” Kessler, principal with Slingshot Solutions, told ADAW last week. “But because it’s new we need to find out what their priorities are.”

“The ACA and parity and Medicaid expansion — that’s the great progress that we’ve made over the last 10 years,” said Kessler. “If we’re smart, we will not get bogged down just in our accomplishments in the last decade.” Based on the history of Tom Price and others who will have influence (see sidebar), Medicaid “is at serious risk for a major overhaul,” said Kessler.

Before the ACA was law, many people were already relying on Medicaid. “We need to think beyond the ACA, to the progress we made in the last 50 years,” Kessler said.

That said, Kessler doesn’t think the ACA is going away overnight. Sen. Lamar Alexander (R-Tennessee) has been clear on the impossibility of getting rid of the ACA and presenting a new health care plan overnight. “Lamar Alexander is very influential, and a friend of our issues, and he has said this is going to be a long process,” said Kessler.

Nevertheless, the people who have received coverage under the ACA are a small percentage of the people who were already getting Medicaid. Even under Medicaid expansion, for the millions of people who became eligible, relatively few took advantage of it “because we didn’t have the infrastructure,” said Kessler. “This is not a population that seeks out help just because there is coverage.”

Kessler is concerned about not taking the benefits people had before the ACA for granted. “I am just as worried about those consumers as I am about the newly covered,” he said.

War on drugs

Another large area of concern for Kessler is criminal justice. It has become accepted that substance use disorders are a health, not criminal justice, problem, in the current administration. But not by everyone. Sen. Jeff Sessions (R-Alabama), Trump’s choice for attorney general, takes a clearly criminal perspective on drugs. “The Obama administration has made great strides to reform mandatory minimums,” said Kessler. “I don’t want to lose the progress we’ve made. We cannot afford a return to the war on drugs. My priority from Day One is this. We have made too much progress to return to the days where our first reaction was to just send people to jail.”

As for Capitol Hill, where Kessler does much of his work on behalf of treatment providers, there is bipartisan support for the field, he said. “I am grateful that the Republican majority in Congress has demonstrated to our community that they are committed to treatment and recovery,” he said. “I say that without reservation.” Of course, it comes down to funding. When appropriations come up next year, he said, “we’ll see how we do. I am hopeful that the Republican majority in Congress will continue to support our community with the same strength they have in the past.”

Meanwhile, it’s important to keep focused, said Kessler. “If we’re looking for something to do on Day One, let’s make sure we let them know how far we’ve come.” Losing Medicaid is not an option, and neither is a return to the drug war.