THE BURNED OVER DISTRICT

With the access to medical care provided by ACA, many opioid addicts were able to access treatment and begin the salvaging of their lives. That access to medication and programs will probably be one of the first things to go when the Republicans start slicing up ACA.

If Congress and President Trump succeed in dismantling the Affordable Care Act, he will have no insurance to pay for his medication or counseling, and he fears he will slide back to heroin.

“If this gets taken from me, it’s right back to Square 1,” he said. “And that’s not a good place. I’m scary when I’m using. I don’t care who I hurt.”

As the debate over the fate of the health law intensifies, proponents have focused on the lifesaving care it has brought to people with cancer, diabetes and other physical illnesses. But the law has also had a profound, though perhaps less heralded, effect on mental health and addiction treatment, vastly expanding access to those services by designating them as “essential benefits” that must be covered through the A.C.A. marketplaces and expanded Medicaid.

The Center on Budget and Policy Priorities, a left-leaning research group, calculates that 2.8 million people with substance use disorders, including 220,000 with opioid disorders, have coverage under the A.C.A. As the opioid epidemic continues to devastate communities nationwide, public health officials say the law has begun to make a critical difference in their ability to treat and rehabilitate people.

“Of all the illnesses, this is one where we’ve seen very dramatic changes and where we stand to lose the most ground if we lose the A.C.A.,” said Linda Rosenberg, president and chief executive of the National Council for Behavioral Health, adding that treatment programs have begun to be integrated into primary care clinics and health care systems nationwide.

During the presidential campaign, Mr. Trump pledged to rid the country of Obamacare but also to address the opioid epidemic and expand access to drug treatment. Many of the states hardest hit by opioids — including Ohio, West Virginia and Kentucky — voted for Mr. Trump, but some Republican governors have expressed concern about what might happen to people being treated for addiction if their party repeals or scales back the health law.

John Kasich, the Republican governor of Ohio, where the Medicaid expansion has covered 700,000 people, has been particularly outspoken about its success in his state. “Thank God we expanded Medicaid because that Medicaid money is helping to rehab people,” Mr. Kasich said during a bill signing in January.

Trump, naturally. was speaking out of both sides of his mouth on this issue but the reality is the GOP in Congress have no use for junkies, except their own children, and will throw them all on the garbage heap as soon as they can.