The Senate Homeland Security Committee released a report in mid-January that received surprisingly little media attention despite its provocative assertion that Obamacare, and particularly its enormous expansion of Medicaid, is a driving force behind the opioid epidemic.
The case laid out by the report is straightforward, logical, and politically unspeakable. It’s an argument generally made in hushed tones until now, and it’s easy to see why. Even the Senate Homeland Security report was swiftly denounced as a “partisan fantasy” peddled by chairman Ron Johnson (R-WI) in what little mainstream media coverage it received. Thou shalt not speak ill of Medicaid.
And yet, the critics could find no way to refute the actual data in the report. They denounced it with thunderous virtue-signaling outrage, attacked those involved in preparing it, criticized arguments it did not make – such as pretending the report claims the opioid epidemic was caused by Medicaid expansion, rather than exacerbated by it – or simply assumed that all critiques of Medicaid and Obamacare must be partisan hit jobs, Q.E.D.
This validates one of the core concerns about politicizing medicine, or any other scientific field, by putting Big Government in charge of it. Rational discussion becomes impossible. Every analysis quickly devolves into a partisan brawl.
The report postulates Medicaid expansion is a contributing factor to the epidemic of opioid abuse – not the sole or original cause, as the report itself and Sen. Johnson took pains to point out, despite mischaracterizations by critics. Much of the opioid crisis involves prescription drugs, which can become addictive even when legitimately prescribed, and are often stolen through fraud and resold on the street. Medicaid expansion greatly increased access to prescription drugs. Medicaid also includes programs to fight drug abuse, but some of those programs involve pharmaceutical treatments that can themselves become addictive, especially when they fall into the hands of street pushers.
It requires no great leap of logic to see the connection between a dramatic increase in access to drugs and a problem driven by easy access to drugs, and yet it is evidently heretical to state that relationship out loud. That’s even more remarkable when the increased use and abuse of painkillers is universally acknowledged as a major element of the opioid crisis.
No one seems to have trouble acknowledging that fact when blaming pharmaceutical companies for creating and pushing drugs, doctors for over-prescribing them, or Americans for reporting remarkably high levels of pain and demanding truckloads of pills to deal with it. The Senate report itself states at the very beginning that the opioid epidemic is complicated, and “most agree that development, marketing, and medical training regarding drug usage – and the resulting over-prescription of opioids – have played a key role.”
Ask if a massive government program that makes it much easier for over one-fifth of the population to get drugs could be part of the problem, however, and you’re a hyper-partisan monster who really just wants to kill poor people by taking away their Obamacare. The Senate committee demonstrated its understanding of just how hot this political potato is by filling the early pages of the report with lavish praise for Medicaid and its good intentions, and repeatedly stating that government spending on drugs is but one factor in a complex crisis that deserves careful analysis.
The report studied hundreds of cases in which Medicaid was abused and defrauded to obtain opioids that were often resold on the streets. The report quotes Sam Quinones’ award-winning book Dreamland: The True Tale of America’s Opiate Epidemic to explain why this outcome was entirely predictable: “We can talk morality all day long, but if you’re drawing five hundred dollars a month and you have a Medicaid card that allows you to get a monthly supply of pills worth several thousand dollars, you’re going to sell your pills.”
Some of the fraud cases detailed in the report go far beyond individual beneficiaries making the sort of calculation Quinones described. Some of them were organized conspiracies involving large numbers of Medicaid beneficiaries recruited to provide inventory to drug dealers. The largest scheme chronicled in the report saw over a billion dollars change hands.
A police officer quoted in the report observed that pharmacists are more likely to fill dubious prescriptions when Medicaid is involved. The Justice Department launched a program over the summer to study the role played real and fraudulent prescriptions for opioids in the drug crisis.
The Senate Homeland Security report further notes that Medicaid fraud is rampant and has not been handled effectively by the government, a fact known to any serious student of the waste, fraud, and abuse that politicians of both parties vow to crack down upon during every election.
Other fraud-susceptible programs such as Medicare, the VA, and the food stamp program are duly cited by the report as sources of opioids.
(Yes, the food stamp program. Among other things, it is well-known to investigators that some SNAP card holders engage in “trafficking” of their benefits, and often purchase drugs with the money they receive. This has been specifically cited as a contributing factor to the opioid crisis. Also, shop owners have been prosecuted for allowing customers to use SNAP benefits to pay directly for forbidden items. One such case documented in the Senate report involved a small grocery store with a back-room stash of “Medicaid-funded OxyContin pills.”)
“The research suggests, however, that Medicaid is the federal program most prone to abuse, and the primary government funding source for the epidemic,” the authors point out.
“There appears to be no limit to the types of schemes used to scam the Medicaid program, from large drug rings that employ beneficiaries as ‘runners’ to fill oxycodone prescriptions, to nurses working the night shift who steal hydrocodone pills from patients. Illicit painkillers obtained with Medicaid cards are being resold at handsome profits nationwide, in places ranging from the streets of Milwaukee to a Native American reservation in upstate New York,” says the report.
Another problem is the illicit use of drugs intended to treat drug addiction, notably suboxone. The attorney general of Kentucky is quoted declaring that “wrongful prescribing of suboxone is flooding our communities with yet another drug that is killing our children.”
It’s not just illicit street purchases increasing in tandem with Medicaid expansion. National Review points to Centers for Disease Control data that “opioid prescribing rates among Medicaid enrollees are at least twofold higher than rates for persons with private insurance.” In Washington State, the CDC found that Medicaid beneficiaries were 5.7 times more likely to die of opioid-related causes.
The most provocative section of the report introduces facts and figures to buttress the argument that opioid abuse has grown worse in states that expanded Medicaid under Obamacare.
“More than 80 percent of the 298 separate Medicaid-opioids cases identified were filed in Medicaid expansion states, led by New York, Michigan, Louisiana, New Jersey, and Ohio,” the report states. “The number of criminal cases increased 55 percent in the first four years after the Medicaid expansion, from 2014 to 2017, compared to the four-year period before expansion.”
It is further noted that drug overdose deaths are increasing almost twice as fast in expansion states, hospital stays for opioid-related issues “massively spiked” after expansion, and Medicaid spending for drug abuse treatment is rising faster in expansion states.
Conversely, as Investors Business Daily notes, eight of the 15 states with the lowest overdose rates did not expand Medicaid. All of these observations should be considered with the usual caveat that correlation does not necessarily indicate causation – there are almost certainly other factors common to expansion states that help to explain their rising addiction rates, although the dramatic increase immediately after the expansion is not easily dismissed.
These assertions are based on official figures that most analysts agree are significantly under-stating the depths of the opioid crisis. One specialist quoted in the Senate report said the opioid epidemic is “deadlier than the AIDS epidemic at its peak.”
Reviewing the Senate Homeland Security report for Forbes, Sally Pipes notes that state Medicaid expansion had the perverse effect of “enrolling able-bodied, childless adults in their Medicaid programs than it does for children and the destitute elderly.” Able-bodied childless adults are also the group experiencing an anomalous increase in mortality rates, which in turn is believed to be strongly influenced by opioid addiction.
“About 80 percent of heroin and fentanyl users spiraled into their addictions after first getting hooked on prescription painkillers. The Medicaid expansion made those painkillers widely and cheaply available,” Pipes notes, succinctly stating the point nobody is supposed to make.
She also tackles the bizarre argument that Medicaid is a net plus because it treats more drug addicts than it creates, which is the sort of argument that only makes sense to people whose capacity for reason has been eroded by decades of worshipping Big Government. (Try this argument for comparison purposes: “Tobacco companies are a net plus for public health because they provide so much funding to treat smoking-related illnesses.”)
Pipes suggests addressing the crisis by rolling back the Medicaid expansion and block-granting funds to states, which could help to drain the bureaucratic swamp that hides so much Medicaid corruption and strongly incentivize states to watch their health-care dollars more carefully.
Such suggestions run strongly against the current political tides, with Democrats pushing hard for even more centralized political control of medicine and ever-larger bureaucracies, with an eye toward midwifing the birth of the doomsday bureaucratic monstrosity known as single-payer socialized medicine. Imagine how bad the opioid crisis will get if everyone gets Medicaid.
But of course, you’re not supposed to imagine that, much less conduct hard research into any aspect of the absolutely forbidden notion that government makes problems worse by subsidizing them.