Saying that Medicaid expansion is fueling the opioid epidemic is kind of like saying that a sump pump can cause flooding in your basement.
The iffy underpinning for this argument is the fact that many of the states that expanded Medicaid coverage under the Affordable Care Act do have higher overdose death rates.
Some conservatives cite that discrepancy as evidence that extending health insurance coverage to low-income adults may be compounding the growing problem of addiction to prescription painkillers and heroin. “Medicaid expansion may be fueling the opioid epidemic in communities across the country, ” Wisconsin Republican Sen. Ron Johnson warns. Researchers say there’s no evidence to support that claim. Over time, access to treatment for addiction should have the opposite effect.
Still, Johnson has asked the Health and Human Services Department to look further into an analysis the department did for him, which found that overdose death rates rose almost twice as much in states that did expand coverage as in those that did not. He wonders whether that’s evidence that Medicaid recipients are using their access to health care to get more painkillers than they need.
The analysis he ordered up only looks at the one year between the time the expansion went into effect in 2014 and when the most recent overdose death numbers came out in 2015. It also doesn’t take differences between states into account. Oregon expanded Medicaid coverage, for instance, and yet fatal overdoses there went down by 6.3 percent.
And it lumps deaths from an overdose of prescription drugs with those caused by illegal substances.
Most glaringly, the Health and Human Services analysis ignores the fact that death rates were already higher in states that expanded Medicaid — and the possibility that states where opioid abuse was already widespread expanded coverage in part to get treatment for residents.
But this latest argument against Medicaid is in line with the conservative view that the state and federal partnership that keeps rural hospitals and nursing homes in business is bad for recipients because it promotes dependency.
No one can say Republicans aren’t trying to protect us from this ill. The health care bill recently defeated by a single vote in the Senate would have cut Medicaid by $772 billion over 10 years. Neither Missouri nor Kansas ever expanded the program, and under Missouri Gov. Eric Greitens, reimbursement to Medicaid providers has been cut.
Yet the opioid epidemic is hitting rural areas with older populations and fewer alternatives for pain relief. And the idea that less Medicaid coverage might translate into less addiction seems not just mistaken but downright cruel.