BEYOND THE NUMBERS
Some Affordable Care Act (ACA) critics claim that its Medicaid expansion is fueling the opioid epidemic by giving Medicaid beneficiaries access to prescription opioid medications, but they’ve got it backwards. In reality, the Medicaid expansion has provided a critical lifeline for people with substance use disorders. As Ohio Governor John Kasich noted, “Thank God we expanded Medicaid because that Medicaid money is helping to rehab people.”
While the rate of drug-related deaths is higher in states that expanded their Medicaid programs than non-expansion states, that disparity became evident way back in 2010, well before the Medicaid expansion essentially took effect in 2014. The Medicaid expansion isn’t driving increased drug-related deaths. Instead, states may have adopted the Medicaid expansion partly to treat a growing opioid problem.
Moreover, the main drivers of recent spikes in overdose deaths are non-prescription opioids like heroin and fentanyl, not the prescription drugs that Medicaid covers. In fact, deaths due to prescription opioids have leveled off since 2011, national Centers for Disease Control and Prevention data show. Across the nation, the number of hospitalizations related to prescription opioid overdoses fell between 2011 and 2014, preliminary research shows. Meanwhile, heroin overdose-related hospitalizations rose in all regions.
Rolling back Medicaid coverage would reverse expansion states’ drug treatment gains. Expansion states have reduced the unmet need for the treatment of substance use disorders by 18 percent. All states’ Medicaid programs cover at least one medically assisted treatment medication, and the Medicaid expansion has granted health coverage to an estimated 99,000 people with an opioid use disorder.
To be sure, as Republican Senator Ron Johnson has noted, Medicaid beneficiaries sometimes use their coverage fraudulently to obtain and distribute opioids — but so, too, do people with private insurance. The ACA also has built-in safeguards to prevent abuse, such as the requirement that Medicaid payments be immediately suspended when there is a credible allegation of fraud against a provider. Providers who are terminated by Medicare can also be terminated from Medicaid and the Children’s Health Insurance Program.
To reduce unlawful prescribing, policymakers should take steps to address that problem rather than roll back coverage gains. States should adopt best practices in drug monitoring programs outlined by the Prescription Drug Monitoring Program Center for Excellence, such as collecting positive identification of people picking up prescriptions, moving toward real-time data collection, and requiring mandatory enrollment for both drug prescribers and dispensers.