The Congressional Budget Office score of the House opioids bill is in, and billions of dollars are shuffling around in the health care industry.

Winners: Inpatient behavioral hospitals, which would receive more than $1 billion in increased federal Medicaid payments from 2020–2023 for patients addicted to opioids.

• This will boost revenues for companies like Universal Health Services and Acadia Healthcare.

Losers: Medicaid insurers.

• The bill also would cement a federal policy that requires insurers to spend at least 85% of their state Medicaid revenue on medical care, and if they fall below the threshold, they must refund the difference back to states. The CBO said this would result in insurers paying back $2.7 billion over the next decade.
• Centene, Molina Healthcare, WellCare Health Plans and UnitedHealth Group are among the largest Medicaid companies.

Many states already follow a so-called medical loss ratio, and the Obama administration established federal Medicaid MLR guidelines in a giant regulation in 2016. The Obama-era rule did not require states to collect excess Medicaid profits, but this bill would.