Politics & Policy

Has Medicaid Made the Opioid Epidemic Worse?

(Photo: Steveheap/Dreamstime)
The states leading the pack in overdoses all expanded the program.

Medicaid hasn’t proven to be the antidote for the opioid epidemic ravaging America, but it just might be adding more poison.

Much opposition to the Republican effort to repeal and replace Obamacare has coalesced around a dubious talking point that Medicaid expansion is the best way to fix the opioid crisis. Some Democrats, such as Senators Bob Casey (Pa.) and Joe Manchin (W.V.), are aggressively pushing the concept that Obamacare’s Medicaid expansion must be maintained in order to provide drug-addiction treatment services. Some Republicans, such as Senators Rob Portman (Ohio) and Shelley Moore Capito (W.V.), have said they want to repeal Obamacare but have concerns about what that will mean for the fight against drug addiction.

On the surface, these might seem like reasonable worries. But there is much more to the story.

While Medicaid may in some cases provide additional treatment options for an addict who is willing to engage, it also provides a “free” plastic card loaded with unlimited government funds that often increases access to opioids.

In 2015, the seven states with the highest drug-overdose death rates were West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, and Massachusetts. These states all have something else in common: All were among the 31 states (not including D.C.) that expanded Medicaid through Obamacare.

Two questions must now be asked: Did expansion actually make the problem worse? And was Medicaid partly responsible for initiating the problem to begin with?

Ohio, which has enrolled more than 700,000 adults in its Obamacare Medicaid expansion, is seeing worse problems with opioids than ever before. This year alone, the state is on pace for more overdose deaths than the entire United States had in 1990, according to an Ohio county coroner.

It’s important to recognize that the problem ultimately stems from legal prescription drugs, not the illegal drug market — though many prescription-drug addicts do switch to heroin as a cheaper alternative. According to Andrew Kolodny, a Brandeis University senior scientist and the executive director of Physicians Responsible for Opioid Prescribing, “overprescribing of opioids is fueling the epidemic.” CDC data indicate that overdose deaths involving prescription opioids have quadrupled since 1999, and that prescription opioids now account for half of all opioid-overdose deaths.

Even more disturbing, studies cited by the CDC have found that “opioid prescribing rates among Medicaid enrollees are at least twofold higher than rates for persons with private insurance.” The CDC’s own study of Washington State showed that a person on Medicaid was 5.7 times more likely to die an opioid-related death than someone not on Medicaid.

Recognizing that Medicaid can be a major source of the very poison causing the drug epidemic, some states have moved to limit and monitor prescriptions of opioids in Medicaid programs. New York, Rhode Island, Maine, and more recently West Virginia and Ohio have taken steps to curb this problem by enacting some limits on prescribing opioids.

But the problem continues. As 15 million able-bodied adults were added to Medicaid through Obamacare, the drug problem only grew worse.

As 15 million able-bodied adults were added to Medicaid through Obamacare, the drug problem only grew worse.

The connection between drugs and massive expansions of government benefits has been seen before. As the food-stamp program expanded nationally, there was an explosion of EBT cards’ showing up in drug arrests. The situation reached a breaking point in Maine, where DEA agents said that it is “common practice for drug dealers to take custody of a drug user’s EBT card either as direct payment or in lieu of immediate payment.”

And while there are strong scientific and documented examples of government benefits’ contributing to rising drug problems, there is not a lot of evidence that these government programs actually help to solve drug problems.

As legislators debate the specifics of repealing and replacing Obamacare, they should resist the feel-good talking point that Medicaid is a silver bullet for solving the opioid epidemic. In reality, Medicaid may be fueling the problem and may be largely responsible for starting the epidemic in the first place.

If lawmakers want to address the opioid epidemic in their states, they should focus on substance-abuse treatment for those who truly need it and are willing to accept it, rather than on maintaining the costly expansion of Medicaid to millions of able-bodied adults.


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