Column: Republicans figure out opioid crisis — it’s the fault of Medicaid expansion! (Spoiler: They’re wrong)
Washington tourists with time on their hands Wednesday could have popped into the Capitol to witness an ancient phenomenon: Senators doing their darndest to prove a partisan fantasy.
In this case, the fantasy was that Medicaid expansion is to blame for the opioid crisis in the United States. The ringmaster was Sen. Ron Johnson (R-Wis.). Johnson has been flogging this notion for the better part of a year, or longer, despite the utter lack of evidence that it’s true — and plenty of evidence that the opposite is true.
The venue Wednesday was a Senate hearing room, where as chairman of the Committee on Homeland Security and Government Affairs, Johnson presided over a session titled “Unintended Consequences: Medicaid and the Opioid Epidemic.”
The witnesses included one anti-Medicaid ideologue, two local prosecutors who testified that they’ve seen a lot of addicts in their work and lots of them seem to be on Medicaid, and two experts who, tactlessly, pointed out that the causes of the opioid epidemic are many and complex, that it started years before Medicaid expansion, and that it involves patients and doctors in Medicare and private insurance as well as the uninsured.
Just because A precedes B doesn’t mean that A causes B. That’s statistics 101.
David Hyman, Georgetown University
Johnson has tried to color his campaign against Medicaid expansion as mere concern for ordinary Americans locked into “dependence on government,” as he put it in a July 27 letter to Health and Human Services Inspector General Daniel Levinson. In the letter he asserted that “drug overdose deaths have risen at an alarming rate” since Medicaid expansion began on Jan. 1, 2014, and that “Medciaid expansion states have been hardest hit.”
A couple of problems arise from this theory. Efforts to demonize Medicaid expansion because it was launched as the opioid crisis really took off confuse correlation with causation, David Hyman of the Georgetown University Law Center warned Johnson’s committee. “Just because A precedes B doesn’t mean that A causes B,” he said. “That’s statistics 101.”
Here’s a more measured look at Medicaid and the opioid crisis:
First, while it’s true as Johnson says that drug overdose deaths have risen at an alarming rate since Medicaid expansion began, they were rising at an alarming rate before Medicaid expansion began. The increase, in fact, began in the 1990s, when doctors began prescribing opioids such as oxycodone in the belief that they would effectively relieve chronic pain with minimal risk of addiction. As Andrew Kolodny of Brandeis University told Johnson’s committee, this was the product in part of the drug industry’s “brilliant, multifaceted marketing campaign that changed the culture of opioid prescribing.”
What really has happened since Medicaid expansion? The opioid crisis has expanded more rapidly than before, but largely because of a sharper rise in the abuse of non-prescription drugs such as heroin and fentanyl, according to the Centers for Disease Control and Prevention. Overdose deaths involving commonly prescribed opioids, which would be those prescribed under Medicaid, have actually leveled out since about 2011, according to researchers at the University of Maryland and UC San Francisco.
Johnson acknowledged the weakness of his case at the outset of the hearing. “This epidemic began way before Medicaid expansion,” he said. He said he was merely pointing out that the opioid crisis may have been an “unintended consequence” of expansion and that expansion may have been a “contributing factor.”
Still, he continued to make the connection between Medicaid expansion and the opioid crisis, even when his own evidence undermined his case. A chart reproduced from a report he released Wednesday pinning the crisis on Medicaid fraud paired five Medicaid expansion states with neighboring non-expansion states, purporting to show much higher increases in opioid deaths in the expansion states from 2013 to 2015. Johnson didn’t seem to notice that the 55% increase in Maine, one of his non-expansion states, actually exceeded the increase in three of his expansion states — Ohio (41%), Maryland (44%) and West Virginia (27%).
The Republican campaign against Medicaid could only make the opioid crisis worse. That’s because Medicaid pays for a huge proportion of opioid treatments, covering fully one-third of those with addiction problems. Most of that spending is in expansion states — in fact, it’s possible that the prevalance of opioid addiction in some states may have helped prompt them to accept expansion (another example of how the relationship between addiction and Medicaid may have been misread). The necessity of continuing Medicaid expansion to address the opioid crisis was made forcibly by Ohio Gov. John Kasich and Arizona Gov. Doug Ducey, both Republicans, last year when congressional Republicans were working hard to eviscerate the program.
Johnson and his fellow Republicans in Congress seem determined to impose cuts on the program, even though the benefits it renders are crystal-clear. Wednesday’s hearing did achieve one benefit, for all that: It showed how threadbare their arguments are.