Health Care Access & Coverage

Policy

Estimated Overdose Deaths Due to the Loss of MOUD in the One Big Beautiful Bill Act

Research Memo: Delivered to House Speaker Mike Johnson and Majority Leader John Thune

By:
  • LDI Staff
Print:
Download PDF

On July 2, 2025, LDI Senior Fellow Zachary F. Meisel, MD, MPH, MSHP, along with Benjamin Linas, MD, MPH and Hana Zwick, both from Boston University, wrote a research memo to House Speaker Mike Johnson and Majority Leader John Thune estimating the loss of Medications for Opioid Use Disorder (MOUD) and resulting overdose deaths attributable to the loss of Medicaid resulting from the One Big Beautiful Bill Act. 

The research memo estimates that 156,000 people to lose access to treatment for opioid use disorder and that the overdose rate among that group will double, leading to approximately 1,000 additional fatal overdoses each year.

July 2, 2025

The Honorable Mike Johnson

United States House of Representatives

Washington, DC 20515

CC: The Honorable John Thune

United States Senate

Washington, DC 20510

Dear Speaker Johnson:

We are writing today as experts in substance use disorder treatment with projections about the effects of the One Big Beautiful Bill Act, which the Senate has passed and is now under consideration in the House. We are researchers at Boston University and the University of Pennsylvania’s Leonard Davis Institute for Health Economics who are associated with the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), which develops and disseminates health economic research to inform substance use disorder treatment.

As described below, we estimate that the bill will cause approximately 156,000 people to lose access to treatment for opioid use disorder and that the overdose rate among that group will double, leading to approximately 1,000 additional fatal overdoses each year.

The Congressional Budget Office estimates that 7.8 million individuals will become uninsured due to loss of Medicaid coverage.1 The U.S. Department of Health and Human Services Office of the Inspector General reported that in 2021, just over 1 million adults, or 2%, of those on Medicaid had Opioid Use Disorder and were receiving Medications for Opioid Use Disorder (MOUD).2 Accordingly, we project that 156,000 people (2%) of the 7.8 million will lose access to MOUD. To model the impact on overdoses, we used the RESPOND (Researching Effective Strategies to Prevent Opioid Death) model, a population-based model that allows simulation of movement onto and off of MOUD, showing overdose and cost outcomes. Applying the RESPOND model allows us to project that the overdose rate among the group losing treatment will double in the first year following coverage loss. Accordingly, we project that the loss of Medicaid from the One Big Beautiful Bill Act is associated with over 1,000 excess fatal overdoses over the course of one year.

We would be happy to further discuss or answer any questions about these estimates.

Sincerely,

Benjamin Linas, MD, MPH
Professor of Medicine at the Boston University Chobanian & Avedisian School of Medicine
Belinas@bu.edu

Zachary F. Meisel, MD
Director, Center for Emergency Care Policy and Research, Perelman School of Medicine
Professor, Emergency Medicine, Perelman School of Medicine
Senior Fellow, Leonard Davis Institute of Health Economics
Zfm@pennmedicine.upenn.edu

Hana Zwick
Research Data Analyst, Syndemics Lab
Hzwick@bu.edu

This communication represents the views of the researchers and not the institutions for which they work.

  1. “Wyden, Pallone, Neal Uninsured Letter,” Congressional Budget Office, June 4, 2025, https://www.cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf.
  2. “Many Medicaid Enrollees with Opioid Use Disorder Were Treated with Medication; However, Disparities Present Concerns,” U.S. Department of Health and Human Services, Office of Inspector General, September 2023, https://oig.hhs.gov/documents/evaluation/3216/OEI-BL-22-00260-Complete%20Report.pdf.

More on Policy at LDI

Search