Tuesday, September 26, 2017

Medicaid and Opioid Abuse

America is suffering through an opioid epidemic. By now we all know that the fault lies with the pharmaceutical manufacturers who are producing and marketing them, with the physicians who are prescribing them willy-nilly and with the government regulators who offered blanket approval for the pills.

If we dig a little deeper into the numbers, as Allyssia Finley does, we discover that many of these prescriptions are being given to people who are covered by Medicaid. In particular, to those who live in states that accepted the Medicaid expansion offered by Obamacare. One reason it is so difficult to repeal and replace Obamacare is that it increases the level at which people can qualify for Medicaid to something like three or four times the poverty level. At that point, the number of those covered rises exponentially. They might not be getting very good medical care, but they have been getting more opioids.

Finley explained:

… government health-care programs are among the biggest suppliers of prescription painkillers. The attorneys general ought to be investigating how Medicaid may help promote opiate abuse and addiction.

Wisconsin Sen. Ron Johnson this summer highlighted a correlation between the ObamaCare Medicaid expansion and opioid overdoses. Data from the Centers for Disease Control and Prevention show that overdose deaths per capita rose twice as much on average between 2013 and 2015 in states that expanded Medicaid than those that didn’t—for example, 205% in North Dakota, which expanded Medicaid, vs. 18% in South Dakota, which didn’t. That’s particularly striking since the energy boom boosted North Dakota’s economy and employment.

ObamaCare defenders note that the disparity in overdose fatalities appears to have begun around 2010—but due largely to sharp increases in a few expansion states, most notably West Virginia. What’s more, the disaggregated data show that the disparity between expansion and nonexpansion states with similar demographics and geography increased markedly after 2013. Between 2010 and 2013, overdose deaths rose by 28% in Ohio and 36% in Wisconsin. Between 2013 and 2015, they climbed 39% in Ohio, which expanded Medicaid, but only 2% in Wisconsin, which did not.

Why do Medicaid patients receive more opioids? Because they receive substandard treatment.

Finley wrote:

For one, Medicaid patients may be more likely to be prescribed opioids—twice as likely, according to two studies, as privately insured individuals. A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015.

State Medicaid programs also favor generics over more expensive branded painkillers with abuse-deterrent formulas. According to the Express Scripts study, generics accounted for 90% of Medicaid opioid medication claims. Large doses of oxycodone, methadone and fentanyl can be obtained cheaply with a Medicaid card and resold for a nice profit on the black market. Sen. Johnson’s review of recent open-source court files and news articles turned up 261 defendants who had been convicted of improperly using Medicaid cards to obtain prescription opioids.

Many states in recent years have set up databases to identify patients at risk for abuse based on the number of prescriptions they fill and pharmacies they visit. But often providers, particularly in emergency rooms where many Medicaid patients seek treatment, don’t have time to check the databases, examine patients for abuse, perform follow-up consultations, or consider alternative analgesics or physical therapy….

Many primary-care providers won’t see Medicaid patients because of the low reimbursement rates, so emergency rooms have been inundated with patients. The wait to see a specialist can last months. Many Medicaid beneficiaries suffering from pain or substance abuse may not be getting the treatment they need.

The Medicaid recipients who are now militating against any changes to Obamacare are not receiving quality medical care. In many cases they are not receiving medical care at all. They receive painkillers.

At least, they are being entrepreneurial. They are selling the pills on the black market, the better to share the benefits of Obamacare.

1 comment:

Webutante said...

Stunning revelation, Stuart. had no idea. Thanks.