Republican Congressman Jim Renacci (OH) argued this week that Medicaid expansion in Ohio and other states may have caused the current opioid crisis ravaging the country. His comments come just ahead of a highly-anticipated vote on the Graham-Cassidy heath care bill, which would end Medicaid expansion and, eventually, the entire program.
“Medicaid was, in some ways, the driver of this opioid addiction,” Renacci said, in an interview on WAKR radio. “…If [the expansion was] needed, how come 19 states that have not expanded Medicaid are doing better than Ohio? And how come Ohio, who’s the number one state dependent on Medicaid expansion, is also the number one state for opioid overdose and addiction? The numbers and the facts just don’t lie.”
Renacci then reiterated that “Medicaid expansion is not the answer” and may have “added to the problem.”
However, the argument that Medicaid expansion led to the opioid crisis — at least in part — is not new and has little basis in fact.
In July, for instance, Sam Adolphsen claimed in a column for the right-leaning National Review,
In 2015, the seven states with the highest drug-overdose death rates were West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, and Massachusetts. These states all have something else in common: All were among the 31 states (not including D.C.) that expanded Medicaid through Obamacare.
Adolphsen added that, “While Medicaid may in some cases provide additional treatment options for an addict who is willing to engage, it also provides a ‘free’ plastic card loaded with unlimited government funds that often increases access to opioids.”
That same month, Wisconsin Sen. Ron Johnson (R) confidently stated in a letter to the Health and Human Services inspector general that, “Because opioids are so available and inexpensive through Medicaid, it appears that the program has created a perverse incentive for people to use opioids, sell them for large profits, and stay hooked.”
Those claims simply don’t hold water.
“Political commentators, including some politicians, use this claim to justify their support for federal Medicaid cuts, despite the fact that Medicaid finances a significant amount of treatment for opioid use disorder,” wrote Andrew Goodman-Bacon and Emma Sandoe in an August column for Health Affairs, a peer-reviewed journal. They continued,
First, trends in opioid deaths nationally and by Medicaid expansion status predate the ACA [or “Obamacare”, in which the expansion was first implemented]. Second, counties with the largest coverage gains actually experienced smaller increases in drug-related mortality than counties with smaller coverage gains. Third, the fact that Medicaid recipients fill more opioid prescriptions than non-recipients largely reflects greater levels of disability and chronic illness in the populations that Medicaid serves.
Specifically, Goodman-Bacon and Sandoe noted, “Opioid use, abuse, and mortality increased rapidly thereafter. In just five years from 1997 to 2002, OxyContin prescriptions for non-cancer pain grew from 670,000 to 6.2 million.” Drug-related mortality rates grew significantly between 1999 and 2013 — a full year before the ACA Medicaid expansion began offering benefits.
“The opioid epidemic started decades before Medicaid expanded,” the two concluded.
As to the claim that states that chose to expand Medicaid experienced higher rates of opioid-related deaths, Goodman-Bacon and Sandoe claimed there was no real correlation.
“Expansion states did have relatively more drug deaths than non-expansion states in 2015, but the upward trend in deaths in expansion states started in 2010, four years before the Medicaid expansion began,” they wrote. “The results are the same if we exclude the six early expansion states. By the simplest criterion for causality, that causes must precede effects, these results cannot be taken as evidence of Medicaid expansion causing these deaths.”
None of those facts have stopped politicians like Renacci from pushing those same debunked claims.
“With cost estimates ranging from $4 billion to $14 billion over the next eight years, Medicaid expansion is fiscally unsustainable and will siphon resources from other vital programs if not repealed — including drug treatment and prevention programs,” Renacci wrote in an op-ed for The Hill on Wednesday. “Recent studies also indicate Medicaid expansion may have increased opioid abuse and overdoses.”
Renacci did not provide details on the studies to which he was referring, although a report by the Washington, D.C.-based think tank the Urban Institute in July showed that Medicaid spending on buprenorphine and naltrexone, two drugs used to treat opioid addiction, had “increased 136 percent nationwide between 2011 and 2016, but with great variability among the states”, according to NPR. Seven states reported increases of around 400 percent.
However, the study’s authors noted that any “parallel between the Affordable Care Act’s Medicaid expansion and spending on addiction medications” simply reflected the fact that more people had the ability to obtain treatment for their addictions, and did not indicate that the expansion was driving up opioid abuse itself.
“What we saw was this gigantic, rapid, ongoing expansion in treatment,” co-author Lisa Clemans-Cope wrote. “It was particularly fast after 2014 when the big Medicaid expansion came into play. There’s definitely an effect of people getting access to treatment. That’s the primary driver of growth of spending.”