The fluorescent lights of the intake office hummed on Thanksgiving Eve in 2014, a stark contrast to the chaotic darkness I’d been living in. I was terrified, exhausted, and sick of myself. My addiction had stripped away everything: my career, my home, my dignity. I was at the absolute bottom, a place where the idea of work was not just impossible, but utterly irrelevant. My only focus was survival, and that meant finding a way out of the hell of active heroin addiction. Beyond the addiction itself, I was suffering from unresolved trauma, and with my substance use came untreated mental health challenges, including severe depression and at times suicidal ideations. A power greater than myself helped me find recovery—but so did Medicaid.
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It was my lifeline, the one thing that stood between me and a death I felt was inevitable.
Now, as Congress debates sweeping Medicaid cuts in President Donald Trump’s “big, beautiful bill,” I see that lifeline being severed for millions of Americans struggling with addiction and mental health challenges. This isn’t just about budget lines; it’s about lives. It’s about reversing the hard-won progress we’ve made in the fight against the overdose crisis, and condemning countless vulnerable individuals to a fate I barely escaped.
In the depths of my addiction, I was unemployable. The idea of holding down a job, showing up consistently, or even performing basic tasks was a cruel joke. My days were consumed by the relentless pursuit of the next fix, driven by a physical and psychological dependence that overshadowed all else. When I finally found a bed in a treatment center, it was Medicaid that covered the cost. Without it, I would have been left to die on the streets, another statistic in a crisis that already claims far too many.
Here is the stark reality: Medicaid is the single largest payer for mental health and substance use disorder (SUD) services in the United States. It covers nearly 40% of all adults with SUD. This isn’t a minor player; it’s the backbone of our nation’s addiction and mental health treatment infrastructure. When we talk about cutting Medicaid, we’re talking about dismantling this critical support system.
While the House of Representatives has made an exemption for individuals with substance use disorders from work requirements in the bill, there are dangerous nuances in the proposed changes. The bill still threatens to rip away healthcare from people with mental health challenges, without recognizing the critical link between substance use disorder and mental health. These are often co-occurring disorders, and denying care for one inevitably impacts the other. Taking away mental health care and essential healthcare services from low-income populations puts an already vulnerable group at a significantly higher risk for addiction. We’ve learned from the so-called “diseases of despair” that without adequate mental health care, individuals will often turn to illicit substances to cope, putting them at a higher risk of overdose.
The idea that these cuts will somehow incentivize people to enter the workforce is a dangerous fantasy. Access to treatment is not a reward for being “ready” or “worthy”; it is a fundamental human right and a public health imperative.
When people are denied access to care, they don’t magically get better. They get sicker. They cycle through emergency rooms, jails, and homelessness, costing taxpayers far more in the long run. . Economists estimate the total cost of opioid use disorder in the United States reached $4 trillion in 2024. Investing in treatment through programs like Medicaid is not an expense; it’s an investment in a healthier, more productive society. The estimated $280 billion in savings over six years that the CBO projects from Medicaid changes will be dwarfed by the increased costs to the government in emergency services, incarceration, and lost productivity.
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We are at a critical juncture in the overdose crisis. After years of escalating deaths, we’ve begun to see glimmers of hope, thanks in part to expanded access to treatment. Drug overdose deaths in the U.S. significantly decreased in 2024, marking the largest one-year decline ever recorded, a testament to the power of comprehensive approaches that include accessible healthcare. To reverse course now, to pull the rug out from under those who are fighting for their lives, would be an act of profound negligence. It would destroy lives and undo the fragile progress we’ve painstakingly made.
While the House package has passed, it is now time for the Senate to do the responsible thing and ensure millions of Americans aren’t left in harm’s way with no access to doctors, emergency rooms, or treatment. I want to imagine a world where people are allowed to live despite our struggles. Where we’re not shunned as criminals or treated like lepers. I imagine us as valued citizens who are part of society.
My own journey to recovery was paved by the grace of a higher power, but also by the practical, tangible support of Medicaid. It allowed me to get the treatment I needed, to heal, and to rebuild a life I thought was lost forever. Congress has a choice: To continue down a path that will inevitably lead to more suffering and death, or to embrace compassion, evidence-based policy, and the understanding that for millions, Medicaid isn’t a luxury—it’s a lifeline.
