Contradicting a popular conservative talking point, new research shows that Medicaid expansion under the Affordable Care Act helped states treat residents with addiction and didn’t change prescription painkiller fill rates.
“This supports the idea that Medicaid expansion has been beneficial in increasing the number of people receiving an important addiction treatment,” said Brendan Saloner, assistant professor at the Johns Hopkins Bloomberg School of Public Health and lead author of the study, which was published this month in the journal JAMA Network Open.
“The ultimate goal of getting people into addiction treatment is giving them better and longer lives,” he said.
The researchers compared California, Maryland and Washington, where Medicaid was expanded under the ACA, to Florida and Georgia, where it wasn’t, and found that prescription fills for the addiction medication buprenorphine combined with the overdose reversal antidote naloxone increased significantly in expansion counties. In comparison, prescription fills for opioid painkillers remained about the same after Medicaid expansion, although more patients paid for those prescriptions using Medicaid.
The new findings stand in contrast to a series of Wall Street Journal editorials, which were written in response to an investigation and a report by Sen. Ron Johnson (R-Wis.) claiming Medicaid expansion helped fuel the opioid crisis.
The new study did not examine whether expansion states had better health or overdose outcomes beyond the expansion of addiction treatment. Study authors did, however, debunk a key piece of Johnson’s report, which noted that fatal drug overdoses increased more rapidly in states that expanded Medicaid under the ACA between 2013 and 2015. That trend was higher in years prior to 2013 and thus it’s unlikely it was caused by the Affordable Care Act changes, the authors explained.
“Ultimately, having Medicaid helps people get access to care, including medication and hospital and [emergency department] care,” said Leighton Ku, a professor at George Washington University’s Milken Institute School of Public Health who was not affiliated with the new research.
Ku noted that there have been broader efforts to become more selective about opioid prescribing and that opioid prescriptions themselves are down. Indeed, the number of opioid prescriptions filled has been falling since 2011, with a 10 percent drop in 2017 alone, according to the IQVIA Institute for Human Data Science.
Ku also pointed to increases in prescriptions of buprenorphine with naloxone as “a very positive sign since there is ample data that shows these are effective ways to help reduce addiction.”
Saloner hopes states that haven’t expanded Medicaid will take the new findings into account, but also noted that expansion alone isn’t enough to address the United States’ opioid crisis.
“While Medicaid is one key ingredient to helping more people, there is a need for more people to get into addiction treatment programs and a need to reduce the great stigma and shame that people have related to addiction,” he said.
“Heroin use and a large portion of illegal fentanyl use are associated with much broader social problems, such as despair and availability of illegal drugs, that Medicaid is unlikely to cure,” Ku said.
Provisional estimates from the U.S. Centers for Disease Control and Prevention found that drug overdoses killed a record-high 72,287 Americans last year, with those number largely driven by synthetic opioids, including fentanyl.