Is Medicaid contributing to the opioid crisis?

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On Wednesday, the editorial board at the Wall Street Journal penned an enlightening piece that critically examines the traditional Medicaid program, Medicaid expansion and impact of the program on the nation’s growing opioid crisis.

Proponents of Medicaid paint a rosy picture about expansion; it boosts economies, reduces the uninsured rate, ends charity care at hospitals and saves lives. As Maine knows from its dysfunctional experiment with Medicaid expansion in 2002, none of these claims are true.

The newest claim by expansion proponents is that widening Medicaid eligibility under the Affordable Care Act, or ObamaCare, will cure opioid addiction and end the crisis. This is another assertion that does not withstand factual scrutiny, and as the Journal’s editorial board notes, the Medicaid program may be contributing to the epidemic.

As previously reported, there are a number of studies produced or cited by the Centers for Disease Control and Prevention that find a link between the Medicaid program and rates of opioid prescription, addiction and death. One study found that Medicaid recipients are prescribed opioids at rates two times higher than those with private insurance. Another state-level study on Washington found that Medicaid recipients were approximately six times more likely to die from opioids than someone not enrolled in the program.

In its editorial, the Journal cites a recent study by Express Scripts Holding, one of the largest pharmaceutical companies in the nation, that found about one in four Medicaid patients were prescribed opioids in 2015. Additionally, Wisconsin Sen. Ron Johnson requested a federal Health and Human Services analysis related to the Medicaid program that found further alarming data.

According to the DHHS analysis, overdose deaths per million residents rose twice as fast in Medicaid expansion states compared to non-expansion states between 2013 and 2015.

There were also noticeable disparities between neighboring expansion and non-expansion states during that time frame. New Hampshire, an expansion state, saw a 108 percent increase in opioid deaths while Maine saw a rise of 55 percent. Maryland, another expansion state, saw an increase of 44 percent while Virginia’s rose just 22 percent.

Staff of Sen. Johnson’s office also found 261 cases around the country of people being prosecuted for illegally using Medicaid cards to obtain opioids. The accused parties would obtain opioids with forged prescriptions and sell them for exorbitant amounts of money.

According to the Journal’s editorial, a detective in Wisconsin told Sen Johnson’s office that 240 oxycodone pills can be bought with a Medicaid card for just a $1 co-pay and illegally resold for upwards of $4,000.

Sen. Johnson wrote a letter to the Inspector General last month that said, “it appears that the program has created a perverse incentive for people to use opioids, sell them for large profits and stay hooked,” and requested DHHS investigate the program to prevent drug abuse.

While more data is needed to determine whether Medicaid is worsening the crisis, one thing is certain; the program is not curbing addiction or ending opioid deaths in expansion states. Further, no evidence exists to suggest expansion would end the crisis in Maine.


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