The main point: Medicaid enrollment and spending cuts will pose particular risk to people with opioid use disorder (OUD).

The details:

Overdose response: In 2023, Medicaid paid for about 39% of the nonfatal emergency department (ED) overdoses, helping people 118,000 times in the 26 states that provide data. States that expanded Medicaid experienced large drops in the percentage of ED visits and hospitalizations for OUD that were for people who are uninsured.
Treatment: The total number of people treated for OUD under Medicaid in 2021 was nearly 1.82 million, or 35% of people treated for OUD. More than half of those treated for OUD under Medicaid (930,910 people) became eligible for Medicaid because of the Affordable Care Act’s Medicaid expansion, meaning cuts for the expansion population will be particularly detrimental.

Why it’s important: When people gain Medicaid coverage, they are more likely to seek treatment for SUD and get treated with lifesaving medications. People in treatment are less likely to overdose and die than those not in treatment.

So dramatic reductions in spending on OUD treatment will likely result in more overdoses and deaths.

The broader context: Members of Congress have boasted about federal grants totaling ~$4 billion over several years aimed at reducing overdose deaths. Many of the same lawmakers voted to support budget proposals that would impose large reductions in the estimated $29 billion Medicaid spends on OUD treatment each year.

Trump has said Medicaid will remain untouched, even as he pushes for reducing federal spending. Many warn that the kinds of cuts the GOP is considering are impossible without cutting Medicaid.