NYT: Medicaid cuts threaten overdose progress

A New York Times editorial outlines how the Medicaid cuts in the budget law will threaten the progress made in reducing overdose deaths.

The details:

• While the federal government was slow to respond to the opioid crisis, local and state health official began to make progress, relying on Medicaid funds to expand addiction treatment. The budget law effectively undoes much of the good that the Affordable Care Act did in expanding Medicaid.
• People with addiction are particularly vulnerable to the loss of Medicaid coverage because Medicaid covers nearly half of non-elderly adults with opioid addiction. Nearly two-thirds of patients getting outpatient treatment for opioid use disorder are on Medicaid. Without insurance, many people will drop out of treatment and relapse.
• The cuts are likely to damage addiction treatment even for people who are not on Medicaid because lost Medicaid revenue will weaken clinics and hospitals that treat addiction.

But: Members of Congress included a provision in the legislation meant to shield people with addiction from losing Medicaid coverage by exempting them from the new work requirements.

• But they will likely need to complete a complex process to receive the exemption, including getting a doctor’s diagnosis of substance use disorder. It requires people to see a doctor to obtain health insurance, but many cannot see a doctor without that health insurance — a Catch-22 that will mean that many people lose coverage despite the exemption.

The broader view: The law includes efforts to crack down on drug trafficking, but the loss of insurance coverage that many rely on to receive treatment undermines other efforts to address the opioid crisis.

Next steps: As a start, Congress should repeal the Medicaid cuts.

• The worst of those cuts will not take effect until late 2026. Lawmakers can repeal the cuts before then and look for other ways to reduce the deficit and offset costs of the tax cuts.
• Short of repeal, Congress could increase funding for addiction treatment to make up for Medicaid cuts, as it did with the fund for rural hospitals.

Our thoughts: The impact of the Medicaid cuts on addiction will be exacerbated by the concurrent cuts to the workforce and funding at key federal health agencies.