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State Autonomy or Federal Negligence? Medicaid Cuts in the Fight Against Opioid Addiction

State and federal governments pay deeply for addiction. One study conducted by researchers at the National Center for Injury Prevention and Control estimates that the opioid addiction crisis has cost the United States more than $78 billion. The cost is staggering.

As President Trump and Congress consider deep cuts to Medicaid, a move designed to give states more freedom and curtail federal funding, public health advocates have to ask: is Trump’s proposed health care reform a nod to states’ independence or federal negligence to address a national addiction epidemic?

The dramatic decrease in funding key to Congress’ Medicaid reform proposal will have a ripple effect among the social service providers, institutions, individuals and families grappling with addiction. Most immediately, people looking for affordable addiction treatment services will struggle to find care. Nearly 30% of people covered by the Medicaid expansion overseen by President Obama are diagnosed with a mental health disorder or substance abuse disorder, accounting for more than 1.2 million Americans across the country. More than a million people will be denied access to life-saving treatment if the Medicaid expansion is retracted. Allowing hundreds of thousands of needy people to lose health coverage would be a national failure.

What services do remain accessible to people seeking addiction treatment will likely be determined based on cost, not efficacy. Medication-assisted treatment (MAT) for opioid dependence can be a clinically effective tool for treating opioid addiction, yet the high price of some MAT drugs like Suboxone may be enough to downsize states’ investments in this treatment modality. This includes Alaska and Kentucky, two of the states hit hardest by the opioid epidemic, where Medicaid pays for nearly 35% and 45% of all buprenorphine-assisted addiction treatment state wide, respectively. Forcing states to revoke health care coverage or specific treatments for people battling an addiction does not make states more independent or autonomous, but it does diminish states’ public services based on federal policy.

The impact of reduced funding for addiction treatment services on a state level will be tragic. With fewer resources to provide, fewer people will be able to access treatment when they need it the most, increasing the risk of accidental overdose. The Comprehensive Addiction Recovery Act (CARA) passed by Congress in 2016 identified first responders’ access to opioid overdose-reversal drug Naloxone as a key strategy for lowering opioid-related fatal overdoses. However, even this last resort intervention will not be secured for first responders until Congress passes a budget appropriating funds for CARA and all the services it outlines. States must wait on Washington to see if they’ll be provided with the necessary financial resources and support desperately needed to curb the opioid epidemic in their communities.

The relationship between states and the federal government on this issue doesn’t need to be complicated. States should be free to respond to their communities’ public health crises, including addiction, as they see fit. Where the federal government can provide much needed financial support to states in their efforts to prevent and treat addiction, particularly addictions to opioid-based pain killers, they have an obligation to do so. Funding effective addiction treatment should be a bipartisan issue.