The Unconscionable Claim that Medicaid Fueled the Opioid Crisis

Republicans like to talk about the need to “reform” Social Security, Medicare and Medicaid. But most of us know that their real desire is to either kill these programs or so damage them that they can effectively be drowned in the bathtub (as Grover Norquist would put it). House Speaker Paul Ryan said the quiet part out loud when he suggested that he had dreamed about slashing Medicaid spending since his kegger days in college.

While we’ve all be talking about shithole countries and government shutdowns, the Republicans have launched what might be their most malicious attack yet on Medicaid. The country is facing a severe opioid crisis, and they are actually trying to blame it on Medicaid. Here is the conclusion Sam Adolfsen reaches at the National Review:

As legislators debate the specifics of repealing and replacing Obamacare, they should resist the feel-good talking point that Medicaid is a silver bullet for solving the opioid epidemic. In reality, Medicaid may be fueling the problem and may be largely responsible for starting the epidemic in the first place.

Claims like that led Republican Senator Ron Johnson to issue a report, write an op-ed and hold a hearing focused on blaming Medicaid for fueling the opioid epidemic.

You might wonder where that kind of nonsense came from. German Lopez says that it all started with a quote from a book by Sam Quinones titled, “Dreamland: The True Tale of America’s Opiate Epidemic.”

For a three-dollar Medicaid co-pay, therefore, addicts got pills priced at thousands of dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.

See if you can spot the problem with that argument, articulated this way by Adolfsen:

[Medicaid] provides a “free” plastic card loaded with unlimited government funds that often increases access to opioids.

They are pretending that Medicaid is simply analogous to having a debit card that you can use to buy prescription opioids, without any involvement from a medical professional. As Lopez points out, Republicans are attempting to blame Medicaid when the entire health care system was at fault.

In the 1990s, private insurers also got swept up in paying for more painkillers as doctors prescribed way more of the drugs (in large part due to a misleading marketing push from major drug companies suggesting, incorrectly, that opioids were safe and effective). Private insurers, like Medicaid, also often paid for these painkillers with little to no cost to the patient. And the patients, like those on Medicaid, sometimes shared or sold their extra pills.

There are other problems with the Republican argument. For example,

  • The data they are relying on is from 2015. The opioid epidemic began in the 1990’s and Medicaid expansion didn’t take effect until 2014.
  • They claim that states that expanded Medicaid are seeing the highest rates of opioid abuse. Given the timing, it is more likely that states like West Virginia, Ohio and Pennsylvania expanded Medicaid precisely because the opioid crisis was so severe and costly.
  • The timing issue creates another problem. Starting around 2011, opioid painkiller overdose deaths began to level off. The current crisis is more about illicit opioids, such as heroin and fentanyl, than conventional opioid painkillers.
  • They also claim that more people on Medicaid are prescribed opioids. But studies have shown that “Medicaid patients, especially those who qualify through a disability and many who do not, are more likely to have chronic conditions and comorbidities that require pain relief.”

As you can see, Republicans are twisting data to support a conclusion they reached previously—which is that they want to undermine Medicaid in order to justify their attempts to kill it. That would be malicious even if we weren’t in the midst of a crisis. But given the exponentially rising death toll from opioids, combined with this administration’s lack of walking their talk when it comes to addressing the issue, it is absolutely unconscionable for Republicans to be undermining Medicaid—the very program that so many states depend on to save lives.

Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly.