The Republican Tax Plan Is a Disaster for Addiction Treatment

So much for fixing the opioid epidemic.


Deep within the Senate tax bill, which passed early Saturday morning, are provisions that could have a big effect on addiction and treatment, leading millions of Americans with substance use and mental health disorders to lose their insurance and increasing the number of Americans dying from alcohol-related causes.

The legislation is still a work in progress, with GOP leaders in the House and Senate ironing out differences with the goal of presenting President Donald Trump with legislation by the end of the year. Amid a spiraling opioid epidemic and record-high alcohol-related deaths, the legislation could put Obamacare on track toward a “death spiral,” says Keith Humphreys, a Stanford psychiatry and former Obama drug policy adviser. He adds that the health-related provisions would hurt most in places that voted for Republican politicians: Those counties that swung for Trump in the election had higher rates of “deaths of despair,” or deaths from alcohol, drugs, and suicide.

While the House bill currently makes no changes to Obamacare, the Senate bill repeals the individual mandate, the part of Obamacare that requires individuals to buy health insurance or face a tax penalty. According to a report from the Congressional Budget Office, such a repeal would cause 4 million Americans to immediately lose insurance and 13 million to lose insurance over the next 10 years. In addition, the CBO predicted a 10 percent spike in premiums.

Of those 13 million who would lose insurance, nearly a third—or some 4 million Americans—likely have a mental or addictive disorder, says Richard Frank, a Harvard health economics professor who has been studying the effects of a potential Obamacare repeal over the past year. His prediction is based on the proportion of low-income Americans who report a substance use disorder or mental illness in the National Survey on Drug Use and Health.

Many of those who would lose insurance—either because they choose not to buy it or because they’re priced out due to rising premiums—are likely to be young or low-income, two groups with particularly high substance abuse rates, notes Keith Humphreys. Just a few weeks of addiction treatment can be prohibitively expensive for many Americans. “Not having insurance will make them vulnerable,” added Humphreys. “One thing that is consistent when you talk to addicted people is how they never thought this would happen to them.”

The Senate tax bill also calls for a 16 percent cut in alcohol taxes over two years. That might sound great—what’s wrong with cheap booze?—but study after study has found that when alcohol taxes go up, deaths go down. Today, with alcohol taxes lower than they’ve been in decades when adjusted for inflation, record numbers of Americans are dying from alcohol-induced causes. Brookings Institute’s Adam Looney estimates that the tax cuts in the Senate bill would result in an additional 1,550 alcohol-related deaths each year. 

Based on the economic impact of all the negative effects that alcohol can have, Looney goes on, “the total local, state and federal tax on alcohol should be roughly four times higher than it is now, and certainly not lower.”


In 2014, before Donald Trump announced his run for president, we knew we had to do something different to address the fundamental challenge facing journalism: how hard-hitting reporting that can hold the powerful accountable can survive as the bottom falls out of the news business.

Being a nonprofit, we started planning The Moment for Mother Jones: A special campaign to raise $25 million for key investments to make Mother Jones the strongest watchdog it can be. Five years later, readers have stepped up and contributed an astonishing $23 million in gifts and future pledges. This is an incredible statement from the Mother Jones community in the face of the huge threats—both economic and political—against the free press.

Read more about The Moment and see what we've been able to accomplish thanks to readers' incredible generosity so far, and please join them today. Your gift will be matched dollar for dollar, up to $500,000 total, during this critical moment for journalism.

We Recommend


Sign up for our newsletters

Subscribe and we'll send Mother Jones straight to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.


Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.


We have a new comment system! We are now using Coral, from Vox Media, for comments on all new articles. We'd love your feedback.