Giving more people the chance to enroll in Medicaid is not only an opportunity for them to live healthier lives, but might actually save them. According to a new study published in JAMA Network Open, Medicaid expansion is linked to a reduction in opioid overdose death rates. The expansion may have saved up to around 8,000 people from dying in overdoses nationally, almost all of which stemmed from heroin and fentanyl use between 2015 and 2017, says the study published Friday, Jan. 10. To put these numbers another way, that’s a reduction rate of about 6%. And when it comes to saving lives, 6% is nothing to sneeze at.
Before we get into the weeds of the study, it’s worth clarifying what Medicaid is and what the expansion includes. Medicaid gives low-income adults (relatively) affordable health insurance. Under the Affordable Care Act (ACA), Medicaid expansions are available today in 37 states plus Washington, D.C. At the time of the study, however, 32 states plus D.C. chose to expand.
If “chose” feels confusing, that’s because it is, but this goes back to the 2012 Supreme Court decision that made Medicaid expansions an option for states. In short, the ACA law is constitutional, but states can opt in or out. Perhaps the one glimmer of good from that decision is that people can now see, ethics aside, that expanding affordable health insurance is indeed a practical way for everyone, including low-income people, to live healthier lives.
This brings us back to the basis of the study. Researchers from the NYU Grossman School of Medicine and the University of California, Davis, studied changes in opioid overdose rates when comparing counties that did expand Medicaid versus ones in states that did not. This study doesn’t show cause and effect, but rather links and associations. To gather their findings, researchers took to the National Vital Statistics System for the cause of death records in more than 3,000 counties across 49 states, plus D.C.
There’s a reasonable margin of error with cause-of-death records, too. This study also seems to be the first to look at this data on a county-by-county level. While the findings are exciting, this also means that more research is needed to really corroborate the results.
Even still, looking at data from between 2015 and 2017, researchers found that Medicaid expansion may have prevented between 1,678 and 8,132 opioid overdose deaths in the states which expanded Medicaid between 2014 and 2016. Looking at it in terms of percentages, that’s an 11% drop in death rates for heroin and a 10% drop for fentanyl. However, the study did not find a link between Medicaid expansion and prescription pills like OxyContin.
The study also found that states with Medicaid expansion had an 11% increase in methadone overdoses. Methadone is used to treat addiction, but it can also be used to treat pain. As Magdalena Cerdá, the study’s senior author, explains in a press release, that’s likely because people who receive Medicaid are more likely to get prescriptions for methadone for pain treatment than the general population. This, unfortunately, may be tied to a greater risk of overdose than when it’s used as addiction treatment.
Ethically speaking, Medicaid expansions are a great thing. Just about every progressive is likely to agree that people deserve good health care that they can actually afford. It’s no surprise that better access to health care may prevent overdose deaths. Of course, this issue is one that’s been hotly contested. Republicans have argued that expanding Medicaid would actually add fire to the opioid epidemic. How? The concern was that if more people had health insurance, they’d have more access to pain killers and then become at risk of a related addiction or overdose. Many states that have rejected Medicaid expansion are also led by Republicans who seemingly want to see instability for the ACA.
Other studies suggest that expanding Medicaid may save lives. As previously covered at Daily Kos, for example, one study found that states with Medicaid expansion saved at least 19,000 adults during a four-year period. The sad flip side to all of this, however, is that while this optional expansion business means we can actually crunch the hard numbers, it also means that real-life people are suffering. For example, as also covered here at Daily Kos, one study estimates that more than 15,000 deaths might have been avoided if the Medicaid expansion had been national instead of state-by-state.
“Past research has found Medicaid expansion is associated with not only large decreases in the number of uninsured Americans, but also considerable increases in access to opioid use disorder treatment and the opioid overdose reversal medication naloxone,” said Nicole Kravitz-Wirtz, the study’s lead author. “Ours was the first study to investigate the natural follow-up question: Is the expansion associated with reductions in local opioid overdose deaths? On balance, the answer appears to be, yes.”
“What I find most exciting about this is we see a reduction in overdoses involving heroin and synthetics,” Cerdá told Vox in an interview. “We haven’t been able to find a lot of policy solutions to do that, but this is one of the first policy measures that does seem to have an effect in terms of reducing overdose deaths from those opioids that are the leading contributors to overdose deaths.”
Imagine if Donald Trump used the opioid epidemic as anything more than a catchphrase?