Opioid Epidemic Linked to Medicaid Expansion

by Rob Roper

An article in Wednesday’s Wall Street Journal (behind a pay wall) shows evidence that the expansion of Medicaid under the Affordable Care Act (ACA) is driving, at least in part, the opioid epidemic that is ravaging the nation.

Under the ACA, states were encouraged, but not required, to expand Medicaid access to people with higher income levels in exchange for increased federal funding. Twenty-nine states took the deal; the rest did not. According to the Department of Health & Human Services, “overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states – those that increased eligibility to 138% of poverty from 100% of the poverty line –… between 2013 and 2015.” Vermont is, of course, one of the 29, and arguably the most enthusiastic.

This trend was geographically consistent as well. For example, deaths increased twice as much in New Hampshire, and expansion state, than they did in neighboring Maine, a non-expansion state. Similar comparisons exist between Virginia and Maryland and Ohio and Wisconsin.

Medicaid allows patients to obtain opiates at a very low cost (the article cites the example of 240 oxycodone pills for a $1 copay), which they can then turn around and sell for thousands of dollars on the street. A study by Express Scripts indicates that 25% of Medicaid recipients are prescribed opiates. Today, roughly one third of all Vermonters is now on some form of Medicaid.

Vermont got a head start on the rest of the nation, expanding Medicaid eligibility in October 2007 under the Catamount Health Plan. By 2014, then Governor Shumlin deemed it necessary to devote his entire state of the state speech to the crisis, and Politico labeled Vermont “America’s Heroin Capital.” Then we promptly expanded Medicaid again under the ACA.

Sen. Ron Johnson (R-Wisconsin) is quoted in the Journal article, “It appears that the program has created a perverse incentive for people to use opioids, sell them for large profits, and stay hooked.” Turns out our state’s addiction to federal tax dollars is fueling our citizens’ addiction to deadly drugs.

Back in June, Governor Scott sent out a press release stating, “Governor Scott remains concerned over the harmful impact this legislation [the bill to Repeal & Replace the ACA] could have on Vermonters, including provisions in the bill relating to the Medicaid expansion under the Affordable Care Act (ACA).” In light of this new information, perhaps now the administration and the legislature should consider the harm the Medicaid expansion has caused to our state.

Rob Roper is president of the Ethan Allen Institute

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