Akron Beacon Journal
How has the Medicaid expansion benefited Ohio? The Urban Institute provides an answer in a new study. The Washington, D.C., research group looked at the patterns across states involving prescriptions of a medication to treat opioid addiction. The medication is buprenorphine, which eases cravings and other withdrawal symptoms. The study found that those states choosing to expand saw a much larger increase in such prescriptions, meaning the medication was more available to Ohioans in need.
That translates to lives saved. Put another way, if Ohio ranks among the states hit hardest by the opioid epidemic, the death toll from overdoses climbing sharply from nearly 20 per 1,000 residents in 2013 to 45 per 1,000 four years later, the outcome could have been much worse.
The study looks at the years 2011 to 2018, the Affordable Care Act approved in 2010, the Medicaid expansion taking effect here in 2014. During that period, the number of prescriptions for buprenorphine increased dramatically, from 1.3 million to 6.2 million nationwide. Much of the increase took place in states with the expansion, where prescriptions rose from 40 per 1,000 Medicaid enrollees to 138 per 1,000. In states without the expansion, prescriptions went from 16 to 40 per 1,000 residents.
No question, as the study cautions, many factors are at work in something as complex as the opioid crisis and how states and communities respond. For instance, Arkansas expanded Medicaid, yet it had one of the lowest rates for prescribing buprenorphine. At the same time, the trend is plain. The study notes that the five states with the highest prescription rates for the medication, Vermont, West Virginia, Montana, Kentucky and Ohio, all expanded Medicaid.
It matters that the Affordable Care Act includes addiction treatment among the “essential benefits” available through the expansion and insurance coverage purchased via the online exchanges. The expansion made coverage accessible for many adults living just above the poverty line. More, there are other medication-assisted treatments, naltrexone and methadone, the study did not examine yet also help addicts through withdrawal to sustained recovery.
Ohioans know how devastating the opioid crisis has been, annual overdose deaths going from 489 in 2005 to more than 5,000 in 2017. The number declined 20 percent last year. Still, the toll far exceeds the 1,500 that alarmed six years ago. Overdose deaths across the country, 70,000 in 2017, have contributed heavily to the decline in life expectancy.
The Medicaid expansion has played a leading role in beginning to slow the wreckage. That contribution adds perspective to the misguided decision of the Trump White House to join fellow Republicans in seeking through the courts to overturn the Affordable Care Act. They argue the elimination of the individual mandate gutted the entire law, including the Medicaid expansion. Yet Congress made no such claim at the time.
The lawsuit serves as an unfortunate distraction. Attention belongs on doing more to address the opioid crisis, recognizing the multiple efforts required, from ensuring the availability of naloxone, a drug that reverses the effects of an overdose, to expanding access to treatment, especially the longer term version that helps addicts rebuild and sustain productive lives.
All that requires resources, and the Statehouse did a better job on that front in the recent budget process. What is shortsighted is applying work requirements to the expansion as Gov. Mike DeWine and Republican lawmakers want, putting many Ohioans at risk of losing ready access to health care.
It is hard to conceive making the necessary progress without the Medicaid expansion. The Urban Institute study affirms the positive difference it has made.