A growing body of research suggests that the vast majority of Obamacare, the Medicaid expansion, is playing a significant role in the fight against the deadly and growing opioid epidemic.
The latest study, published in Health Affairs by Brendan Saloner, Rachel Landis, Bradley Stein, and Colleen Barry, found that after West Virginia expanded Medicaid, the number of people diagnosed with opioid use disorder under the public insurance program rose – and, crucially, the number of people on buprenorphine, one of the two gold standard medicines for opioid addiction, went up well.
This is especially true for West Virginia. It's the state with the highest drug overdose death rate in the country, at 57.8 per 1
The Health Affairs The study suggests that the Medicaid expansion, which began in 2014, helped get more people into treatment. The number of people under the Medicaid expansion is diagnosed with opioid use disorder more than doubled between January 2014 and December 2016, and the number of people on buprenorphine treatment increased sixfold.
Studies show buprenorphine and methadone reduce the mortality rate among opioid addiction patients by half or more and keep people in treatment better than non-medication approaches.
The changes were not even across all groups. For example, non-Hispanic white enrollees were more likely to get buprenorphine than their Hispanic and black counterparts.
The study has a few limitations. For the first time, this can not definitively prove all these people are getting into treatment for the first time because there is no data for the population before enrolling in Medicaid.
The study comes as President Donald Trump continues his efforts to abolish Obamacare, which could cost millions of health coverage. , and as Republicans continue to advocate against Medicaid in general. But the study shows the Obama administration can help to scale back a tool that is helping to cope with a public health crisis that now kills dozens of thousands of Americans every year.
Obamacare has helped confront opioid epidemic
The new study is the latest in a The growing body of research suggests that Medicaid Expansion and ObamaCare more broadly help to combat the opioid epidemic. One 2018 study, in JAMA Network Open found that the Medicaid expansion did not lead to more buprenorphine prescriptions.
Another 2018 study in Health Affairs concluded that Obamacare may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans.
And a 2017 analysis from researchers At the Harvard Medical School and the New York University, found that without Obamacare, an additional 220,000 people with opioid use disorders would lose insurance coverage for treatment.
To some degree, this is a healthy sense: an expansion in health insurance has made It is easier for some people to pay for a form of health care.
But some Republicans, led by Sen. Ron Johnson (WI) has tried to argue the opposite – that the expansion of Medicaid has made the opioid crisis worse. Johnson held a hearing and issued a report last year on making this claim.
After ObamaCare encouraged states to expand Medicaid to include everyone at or below 138 percent of the federal poverty level (around $ 16,750 a year for an individual), more people got access to opioid painkillers, since they could now get doctors to prescribe drugs and had a health plan to pay for opioids. And that may have led them to addiction or at least make opioids more available for misuse and sell on illegal markets.
The evidence suggests that this is not the case. The study in JAMA Network Open in particular, found that opioid analgesic prescriptions did not seem to increase as a result of the expansion of Medicaid, even as prescriptions for buprenorphine treatment.
Johnson's claim also conflicts with the chronology of the opioid epidemic. Medicaid did not expand under Obamacare until 2014 – well after the opioid overdose deaths began rising (in the late 1990s), after the Centers for Disease Control and Prevention in 2011 declared the crisis an epidemic, and as the crisis came to include illicit opioids, such as heroin and fentanyl, more than conventional opioid analgesics.
Meanwhile, experts have long argued for a federal investment in the tens of billions of dollars in addiction treatment. (For a reference, a study from the White House Council of Economic Advisers linked to a year of opioid crisis to $ 500 billion in economic losses.) This could help fill a huge gap in treatment today: Federal data suggests one in 10 people with any substance
Some of that investment could come through grants programs dedicated to the crisis or new safety net programs for the treatment of the disease. addiction treatment. But a lot of it can be done through Obama or other expansions in access to health care; After all, if addiction is really a medical condition, as experts and advocates argue, then it should be treated through the traditional health care system just like any other disease.
The West Virginia study suggests that's how Medicaid expansion works the real world, as more people get insurance to pay for treatment and then actually get into treatment. But if people lose that insurance, they could be left stranded – leaving them without the care they need to cope with their addiction, as America deals with its deadliest drug overdose crisis in history.
For more on how Medicaid could help combat opioid epidemic, read my in-depth report on Virginia's unique Medicaid experiment.