Obamacare’s Medicaid enlargement, which gave hundreds of thousands of low-income adults entry to medical health insurance, was linked to a 6 p.c
Obamacare’s Medicaid enlargement, which gave hundreds of thousands of low-income adults entry to medical health insurance, was linked to a 6 p.c discount in opioid overdose loss of life charges — doubtlessly stopping 1000’s of deaths — in response to a brand new study in JAMA Community Open.
The research checked out what occurred in counties in states that expanded Medicaid below the Inexpensive Care Act by 2017, in comparison with counties in states that didn’t broaden Medicaid, accounting for variables like demographic and coverage variations. The Medicaid enlargement was made elective in a 2012 Supreme Court docket ruling, and solely 32 states and Washington, DC, had opted to broaden by the research interval (with the whole rising to 37 prior to now few years).
The research helps put to relaxation claims by some Republican lawmakers, notably Sen. Ron Johnson (WI), that the Medicaid enlargement made the opioid disaster worse by increasing entry to painkillers. The brand new research, echoing others before it, suggests the Medicaid enlargement had the other impact, and that there wasn’t a hyperlink between the enlargement and extra deaths brought on by painkillers, with the potential — and comparatively unusual — exception of methadone utilized in ache remedy.
The researchers discovered that Medicaid enlargement counties had a 6 p.c decrease charge in opioid overdose deaths than non-expansion counties. That was principally resulting from an 11 p.c decrease charge of deaths involving heroin and a 10 p.c decrease charge for deaths linked to artificial opioids excluding methadone (primarily fentanyl, now the most important contributor to deadly drug overdoses within the US).
“What I discover most enjoyable about that is we see a discount in overdoses involving heroin and synthetics,” Magdalena Cerdá, one of many research’s authors, instructed me. “We haven’t been capable of finding quite a lot of coverage options to try this, however this is among the first coverage measures that does appear to have an impact when it comes to lowering overdose deaths from these opioids which are the main contributors to overdose deaths.”
There was no affiliation between the Medicaid enlargement and deaths involving pure and semi-synthetic opioids, which incorporates conventional painkillers like OxyContin and Vicodin.
There was, nevertheless, a hyperlink between the Medicaid enlargement and an 11 p.c improve in overdose deaths involving methadone. Though methadone is used very effectively in dependancy remedy, the good majority of deaths linked to methadone, based mostly on multiple investigations into the topic, are a results of methadone utilized in ache remedy. That appears to be what’s happening right here: Medicaid plans have historically favored methadone for continual ache remedy — as a result of it’s so low-cost — so maybe Medicaid led to a rise in entry to methadone for ache remedy and, in consequence, extra misuse and overdoses.
“This doesn’t in any manner detract from the notion that methadone is an efficient strategy to deal with opioid use dysfunction and scale back future overdose deaths,” Cerdá stated, citing proof that methadone reduces the mortality charge amongst opioid dependancy sufferers by half or more and keeps people in treatment higher than non-medication approaches. “Actually, the seemingly clarification right here is round methadone used to deal with ache.”
Nonetheless, methadone is just concerned in a fraction of opioid overdose deaths. On internet, the research discovered the Medicaid enlargement seemingly prevented deadly opioid overdoses: “our findings counsel that these states would have had between 83,906 and 90,360 deaths within the absence of the enlargement, implying that Medicaid enlargement might have prevented between 1,678 and eight,132 deaths in these states throughout these years.”
That results in a nuanced story: The Medicaid enlargement might have contributed to some extra deaths in ache remedy — though there’s no empirical proof that is true for conventional painkillers, because the research and another one discovered — however nonetheless ended up saving much more lives by increasing entry to dependancy remedy.
Different analysis backs this up. A 2019 study printed in Well being Affairs found that after West Virginia expanded Medicaid, the variety of individuals recognized for opioid use dysfunction below this system rose — and the variety of individuals on buprenorphine, one of the gold-standard medications for opioid addiction, elevated as effectively. In different phrases, the Medicaid enlargement appeared to broaden entry to evidence-based dependancy remedy.
The research has some weaknesses. For one, it’s the primary research wanting on the results of the Medicaid enlargement on overdose deaths on the county stage. On condition that, research utilizing totally different fashions and assumptions might come to totally different conclusions. Extra analysis is required to confirm the findings.
The information used within the research for overdose deaths generally undercounts opioid overdose deaths, as a result of the medicine behind some overdoses aren’t all the time recognized. The research additionally measured the results of the Medicaid enlargement on the final inhabitants, not simply the beneficiaries that immediately benefited from Medicaid. (A research solely Medicaid beneficiaries may discover even higher outcomes for the enlargement.) And the research handled the enlargement as a binary — whether or not states enacted the enlargement or not — which blurs variations between states’ Medicaid applications that might produce totally different results.
For Cerdá, these caveats are room for extra analysis to tease out how Medicaid might carry down overdose deaths. She additionally desires to review the rise in methadone deaths, which may assist policymakers work out easy methods to mitigate any dangers of the enlargement whereas maintaining the advantages.
For now, although, the research means that state policymakers have a coverage lever accessible to them to doubtlessly battle the continuing opioid epidemic, which has contributed to greater than 700,000 opioid overdose deaths since 1999. As a part of Vox’s Rehab Racket project, I’ve heard time and time once more how important insurance is to acquiring high quality dependancy care. Lawmakers within the 13 states that haven’t moved to broaden Medicaid now have a window to ameliorate not less than a part of the issue of poor insurance coverage protection resulting in extra circumstances of untreated dependancy and overdose deaths.