Is a new report linking Obamacare with the opioid epidemic sound science, or just politics as usual?
Last month, Republican Sen. Ron Johnson of Wisconsin oversaw a committee session titled “Unintended Consequences: Medicaid and the Opioid Epidemic.”
Johnson argued that the Medicaid expansion, which took effect in 2014 through the Affordable Care Act (ACA), is partly to blame for the United States’ growing opioid epidemic.
“Overwhelming evidence shows that Medicaid has inadvertently contributed to the national tragedy that is the opioid epidemic and has taken a toll that is playing out in courtrooms across the nation,” states the report.
Among other accusations, the report also states:
- The ACA has made it easier and more profitable to fill opioid prescriptions and sell pills illegally.
- Drug overdose deaths are rising almost twice as fast in Medicaid expansion states compared with non-expansion states.
- Medicaid is fraught with loopholes and incentives, creating fraud and abuse.
However, public health policy experts have condemned the report, calling it a thinly veiled attack on healthcare entitlements.
“What you are really seeing here is a politicized argument with very little public health merit, sustained by observations that an unscrupulous few doctors and patients are using Medicaid funds to gain access to pills and selling them on the street,” James Hodge, JD, a professor of public health law and ethics at Arizona State University, told Healthline.
Trend has been going on awhile
Critics, including the watchdog group Public Health Law Watch, have refuted Johnson’s assessment based on many factors, including the timeline of the opioid epidemic itself.
Experts say the ball was set in motion long before the Medicaid expansion took effect in 2014.
In one chart published by the Annual Review of Public Health, the rampant growth of both opioid sales and opioid-related deaths goes back almost two decades, beginning in the late 1990s.
Policy experts say that mortality trends in Medicaid expansion states also predate the expansion itself.
“What that analysis leaves out is that the rate of increase was higher in the expansion states in all the years preceding Medicaid expansion,” Brendan Saloner, an assistant professor in health policy at Johns Hopkins University in Maryland, told Healthline.
“So, the notion that Medicaid expansion was the precipitator of the higher rate of increase is not born out in the data,” Saloner added.
It’s also worth pointing out that every expansion state isn’t necessarily worse off than non-expansion states.
The Los Angeles Times points out that Maine, a non-expansion state, had a 55 percent rise in overdose deaths between 2013 and 2015. That’s more than several expansion states deeply affected by the opioid epidemic, including West Virginia at 27 percent and Ohio at 41 percent.
It’s hard to understate the continuing impact of the opioid epidemic.
The New York Times reported that 64,000 people died of drug overdoses in 2016.
That amounts to the “largest annual jump ever recorded in the United States,” the newspaper stated.
While drug-related deaths certainly haven’t slowed down since the Medicaid expansion, critics say there’s nothing to suggest this growing number has anything to do with the program itself.
In fact, prescription drugs may not even be driving the current rash of opioid-related deaths.
In another chart published by the Centers for Disease Control and Prevention, the number of deaths from heroin and highly potent synthetic drugs such as fentanyl have spiked in recent years, while deaths from prescription opioids rose at a significantly smaller rate.
But, those factors aren’t necessarily mutually exclusive.
Medicaid has helped in some areas
In examining the larger picture of the United States’ opioid epidemic, both Hodge and Saloner say that singling out Medicaid as a cause of the epidemic is poor policymaking.
They also agree that there’s no data to suggest that private insurers are in any way exempt from the many criticisms being lobbed at Medicaid.
“It may not be any different than private healthcare resources being used and paid for by employers and subsidized through the federal government,” said Hodge. “To target Medicare and Medicaid, suggesting that it is an exclusive contributing factor, is absurd.”
On the flip side, Medicaid expansion has had a direct effect on treatment programs for substance use disorders.
In a letter addressed to Sen. Johnson, Saloner points out that the impact of the expansion has been multifold.
It has expanded funding for substance use disorder treatment and made it easier to access essential drugs.
According to a study cited by both Saloner and Public Health Law Watch, prescriptions of buprenorphine — one of the primary medications to treat opioid addiction and withdrawal — went up 70 percent in expansion states following the 2014 Medicaid expansion.
“The bottom line is that in expansion states we’ve seen a big pickup in Medicaid paying for drug and alcohol treatment for people with substance abuse problems,” said Saloner. “In terms of getting people access to treatment and helping to put in place a new kind of financial model, I believe Medicaid expansion has been hugely helpful.”
Medicaid goes far beyond the scope of the opioid epidemic. To undercut its value to a large swathe of America’s most vulnerable is a dangerous proposition, says Hodge.
“For millions of Americans who fundamentally lacked all access to all healthcare prior to expansion, and to open the door for those persons to get it and then blame a massive opioid epidemic, which has been around for 20 plus years, on its arrival — well before Medicaid expansion ever started — it really does boil down to poor policy and poor assessment,” he said.