NATURAL EXPERIMENT – MEDICAID EXPANSION BOOSTED USE OF AMERICAN MEDICINE’S OPIOID CURE, PREDICTABLY WORSENING THE CRISIS
The evidence is direct, uncomplicated, and congruent with all other lines of evidence pointing to experts’ gold standard opioid cures fueling the lethal crisis
by Clark Miller
Published January 20, 2024
The analyses and data were put together by a privately-funded organization with transparent political and social policy agendas. Neither of which seem able to be used to discount the established data and trends. From the report from Foundation for Governmental Accountability –
Their key findings –
And a graphic illustrating trends for expansion along with opioid overdose incidence for one state pre- and over pandemic years –
It’s important to affirm, as reported widely, that a primary and successful desired outcome of Medicaid expansion has been to increase enrollment of individuals trapped in compulsive opioid use and the crisis on the rationale that state insurance paying for increased access to America’s gold standard, proven treatments for opioid use disorder (OUD) including medications for OUD (MOUD) would benefit them and predict gains against the lethal crisis.
We’ll get to that in just a bit.
Results were seized on by media outlets that may share agendas and perspectives with FGA.
But the key conclusion from FGA – no evidence for opioid crisis gains correlated with measures of Medicaid expansion – is validated in research journal reports, like this –
Concluding that –
Our nationwide, population-based study found no evidence that Medicaid Expansion reduced OORM rates among people with lower education attainment. This more refined model does not corroborate previous empirical studies reporting either positive or negative associations between Medicaid expansion and OORM rates . . .
Our capacity to directly compare our results with past evidence, however, is limited, since to improve the rigor we narrowed analyses to less educated individuals to approximate the low-income population eligible for Medicaid; adjusted the outcome for unreported opioid overdoses; and controlled for the percentage of fatal overdoses from synthetic opioids including fentanyl.
They provided a succinct explanation of the rationale and predictions driving Medicaid expansion for the opioid crisis –
Medicaid Expansion under the Affordable Care Act (ACA) is a major structural intervention with a potential to reduce opioid overdose mortality rates among socioeconomically disadvantaged populations. First, Medicaid Expansion may reduce risky opioid use by improving access to substance use disorder (SUD) treatment among low-income populations previously ineligible for coverage under traditional Medicaid policies (Beronio, Glied, & Frank, 2014). Empirical evidence supports this hypothesis: states that expanded Medicaid under ACA had higher rates of admissions to SUD treatment programs (Meinhofer & Witman, 2018; Saloner & Maclean, 2020) and of prescriptions for medications for opioid use disorder (MOUD) such as buprenorphine and naltrexone compared to non-expansion states . . .
And important note about a potentially confounding factor –
While some have hypothesized that ACA may increase overdose rates by increasing opioid pain relievers (OPR) prescriptions (see, e.g. Adolphsen, 2017), research has found no evidence of a positive association between Medicaid Expansion and OPR prescription rates (Cher, Morden, & Meara, 2019; Saloner et al., 2018; Sharp et al., 2018) or OPR-related overdoses (Kravitz-Wirtz et al., 2020; Swartz & Beltran, 2019).
And an unusually candid and direct assessment of findings –
Let’s go back to the NIH Library of Medicine reproduced report –
Outside of The Matrix and within the real world of what is established by research evidence, the statement would have been composed as:
“Our findings are those expected given the evidence that Medicaid expansion increased SUD treatment utilization and based on what decades of evidence establish regarding the use of substitute opioids methadone and buprenorphine as if those constituted beneficial treatments for compulsive opioid use, instead established as predictably exacerbating the lethal epidemic, along with evidence establishing America’s SUD ‘treatment’ practices and programs as not constituting treatments of any type, instead predicting harm. The increased allocation of public funds to expose vulnerable compulsive substance using individuals to the known harm-predicting ‘treatments’ of course predicts higher rates of illness and deaths. Our findings are somewhat unexpected in that they did not show more clearly the predicted harms.”
Not as clearly as the continuously increasing provision of doctor-prescribed Medicaid-funded medication assisted treatment (MAT) to compulsive opioid users, pre-pandemic, over the pandemic, and now post-pandemic, while opioid “deaths involving buprenorphine” predictably mount year after year.