by Mary Lou Masters
Medicaid expansion has failed to prevent the ensuing opioid crisis, with 14 out of the 15 states with the highest overdose rates being expansion states, according to research exclusively shared with the Daily Caller News Foundation.
The research from the Foundation for Government Accountability (FGA) indicates that while Medicaid expansion was intended to combat the opioid crisis, it hasn’t helped and “may be making it worse,” co-authors Michael Greibrock and Sam Adolphsen wrote. Of the states with the lowest overdose rates, half of them are non-expansion states, and another two only recently expanded.
“During Medicaid expansion battles, the program was touted as an answer to the drug crisis, but evidence fails to support that claim,” Greibrock and Adolphsen stated. “It increases access to prescription painkillers, is full of fraud, and keeps able-bodied adults out of the workforce. These are all major contributors to the drug crisis, and as a result, Medicaid is more likely to contribute to the problem, not solve it.”
The latest data available, when there were 36 expansion states plus Washington, D.C., indicates that besides Tennessee, all of the states with the highest overdose rates — Arizona, Connecticut, Delaware, Indiana, Kentucky, Louisiana, Maine, Maryland, New Mexico, Ohio, Pennsylvania, Rhode Island, Washington DC and West Virginia — were expansion states, according to the research.
Within the first year of the COVID-19 pandemic, Medicaid expansion states saw more of an uptick in drug overdose deaths than non-expansion states, according to the research.
The ten states that utilized Medicaid the most from 2014 to 2020 — Alaska, Arkansas, California, Kentucky, Louisiana, New Mexico, New York, Rhode Island, Washington, D.C. and West Virginia — more than doubled their overdose rates, amounting to 39.69 deaths per 100,000 individuals, according to the research. The rates of the ten states with the least Medicaid usage experienced a smaller uptick, with 19.13 deaths per 100,000 people, increasing their overdose rate by less than a third.
Medicaid expansion states also experience a higher rate of “suspected overdose” visits than that of non-expansion states, with Medicaid and Medicare making up for two-thirds of all opioid-related charges in emergency departments, the research indicates.
“This shows that simply expanding Medicaid did not help states turn the tide on the drug epidemic,” Greibrock and Adolphsen wrote. “Overall, expansion states had an age-adjusted overdose rate of 31.47 people per 100,000 and non-expansion states had a lower rate of 24.73 people per 100,000.”
Five out of the ten states with the lowest overdose rates weren’t expansion states — Georgia, Kansas, South Dakota, Texas and Wyoming — and two just expanded within the year, Idaho and Nebraska, the research indicates.
The ten states with the greatest usage of Medicaid expansion experienced nearly three times as many babies born with Neonatal Abstinence Syndrome (NAS) – a condition often resulting from their mother’s opioid usage – than non-expansion states, with 11.49 NAS births per 1,000 deliveries compared to fewer than four, respectively.
More mothers enrolled in Medicaid give birth to babies with NAS, delivering NAS babies at almost twice the overall rate, and greater than eight times than those who are privately insured, the research indicates.
In West Virginia from 2017 to 2019, for every 1,000 births, 85.8 NAS deliveries were made under Medicaid’s coverage while only 12.7 were privately insured, according to the research. Similarly, in Arkansas from 2017 to 2021, Medicaid covered over 96% of NAS births.
Individuals that are enrolled in Medicaid are more likely to admit they’re addicted to painkillers than both those who have private insurance or aren’t covered, the research indicates. This is largely due to the “fraud” involved with Medicaid coverage that results in benefits and services being abused.
Medicaid expansion isn’t solving the opioid crisis problem, but bolstering the workforce will, as unemployed individuals are almost two times as likely to use non-medical, prescription opioids, and more than twice as likely to use non-medical, prescription stimulants, than full-time employees, according to the research.
“To truly address the drug crisis, instead of enrolling more individuals in Medicaid, states and the federal government should reform the program to make sure it prioritizes the truly needy. This includes adding work requirements that will move able-bodied adults off Medicaid and back into the workforce,” Greibrock and Adolphsen stated.
Republican Arkansas Gov. Sarah Huckabee Sanders pushed for work requirement incentives for able-bodied “enhanced Medicaid coverage” recipients in February.
The Obama administration’s Affordable Care Act (ACA) expanded Medicaid in hopes to help Americans with lower incomes by affording coverage to those 65 years old and under with incomes up to 138% of the federal poverty level. The ACA initially sought nationwide expansion, however the Supreme Court reverted the power to choose to the states.
Medicaid expansion, funded largely by the federal government with the states making up the rest, allows more people access to health care, leading blue states to swiftly enact it. Many red states dislike expansion as it is a form of welfare that uses taxpayer dollars for funding.
There are 12 states that have not expanded and 38 states that have, as well as Washington, D.C., with South Dakota planning to join in July.
“CMS [Centers for Medicare & Medicaid Services] cannot speculate on outside research that has not been made public. We would refer you to the researchers for commentary on their work,” a CMS spokesperson told the DCNF. “Broadly, we would note that Medicaid expansion is key to improving health outcomes, addressing longstanding health disparities, and connecting people to needed essential care. Nearly four million additional people could benefit from this coverage if Medicaid is expanded in all states.”
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Mary Lou Masters is a reporter at Daily Caller News Foundation.
