Plan on Opioid Crisis is Missing a Proven Strategy that Could Double Number of Those Getting Treatment

A June 11 press release headlined: “CMS leverages Medicaid Program to combat the Opioid crisis,” touts the Trump Administration’s commitment to addressing the growing problem of opioid addiction.  In the press release, Secretary Azar is quoted as saying: “Today’s announcement reflects the Trump Administration and HHS’s commitment to helping states use Medicaid to support treatment for this condition and other challenges produced by our country’s crisis of opioid addiction.”  While “enhancing medical technology” and “addressing neonatal abstinence syndrome” are no doubt worthy goals, Health and Human Services Secretary Alex Azar misses the main point of how Medicaid could make the biggest impact on addressing the opioid epidemic – covering more uninsured adults so they can afford treatment if needed.

Here’s all you need to know about the major oversight in the Administration’s announcement:

  1. Adults ages 19-64 who have opioid addiction are twice – yes, twice – as likely to have had treatment for that addiction if they have Medicaid compared to being uninsured or having private insurance.
  2. Medicaid expansion is targeted to adults ages 19-64 who are low-income (making less than $28,676 for a family of three) and usually working or are members of a working family in professions such as hotel housekeeping, construction, seasonal work and other industries that don’t often offer health coverage. 34 states (and DC) have adopted Medicaid expansion under the Affordable Care Act and are now covering millions of people with Medicaid health coverage that allows people struggling with addiction to get treatment.
  3. In the seventeen “holdout” states that have not adopted Medicaid expansion, more than two million Americans who could have health coverage – including comprehensive treatment for opioid addiction – are left without insurance in the “coverage gap.”

There exists a solution administered by CMS to get over two million Americans into an excellent health care coverage program that has proven success and could  double the likelihood of those with opioid addiction getting the treatment they need.  Yet not one word of Azar’s opioid press release mentions this fact. Indeed, one is hard pressed to find anything on the CMS website encouraging states to extend coverage to more uninsured people.

Virginia’s legislature and Governor crafted a bipartisan Medicaid expansion compromise just last month that means over 400,000 people in Virginians will now have access to affordable health coverage – including access to addiction treatment.  As of this writing there is has not been a single news release from CMS about this achievement or indeed any public indication on how they will help the state implement this coverage.

Health policy is a complex area where decisions made by government at both the federal and state level have a huge impact on the lives of millions of Americans. It’s often easy to cherry-pick a few policies or reforms that most everyone agrees on whether it is helping newborns and their parents, using telemedicine to address rural health shortages, or helping people get non-urgent care from a family doctor rather than in a hospital emergency room. Unsurprisingly, politicians or policymakers making speeches and issuing press releases about these changes sometimes try to distract the public from solutions that don’t fit in with their political philosophy. That is likely the case here. We know if holdout states like North Carolina, Texas, Florida and Georgia expanded Medicaid it would mean thousands of Americans could immediately afford decent treatment for opioid addiction.  It’s not that the facts about Medicaid’s success aren’t readily available, it is just that the current Administration doesn’t want to talk about it.

Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.