I found the article at the Center on Budget and Policy Priorities addressing the claim that Medicaid expansion caused the “opioid epidemic” interesting:
The latest data from the federal Agency for Healthcare Research and Quality highlight the importance of the Affordable Care Act’s (ACA) Medicaid expansion in increasing insurance coverage among people with opioid-use disorders (OUD).[1] Our analysis of these data, which offer a comprehensive picture of opioid-related hospitalizations around the country, finds that the share of hospitalizations in which the patient was uninsured fell dramatically in states that expanded Medicaid: from 13.4 percent in 2013 (the year before expansion took effect) to just 2.9 percent two years later. This steep decline indicates that many uninsured people coping with OUDs have gained coverage through Medicaid expansion.
In addition, the data rebut claims that Medicaid expansion contributed to the opioid crisis. Opioid-related hospitalizations were higher in expansion than non-expansion states as early as 2011, three years before Medicaid expansion took effect, and have been growing at roughly the same rate in expansion and non-expansion states since expansion took effect. Medicaid is part of the solution to the opioid crisis, not a cause.
My only comment is not about the subject matter, whether Medicaid expansion did or did not contribute to the increased abuse of opioids, but on how you go about drawing conclusions. Their own data do not support their conclusion. They do support the conclusion that Medicaid expansion is not the only factor. They do not demonstrate that Medicaid expansion is not one of several factors.
It might be the case that other pathologies at work in the states in which Medicaid was expanded under the PPACA produced the abuse. It might be that states in which abuse was increasing rapidly were more likely to expand Medicaid. It might be the case that Medicaid expansion increased the likelihood of abuse. All of those might be the case or none of those might be the case or some combination, possibly with additional factors. What we do know is that abuse has increased and states in which Medicaid was expanded saw higher rates of increase. Full stop.
Someday researchers without axes to grind might get to the bottom of the question and that might help us formulate solutions. Clearly, we’re not at that point.
A common problem with “non-partisan” think tanks.
Looks to me like OUD sufferers hit the books as patients because of availability of treatment through expanded Medicaid.
What we really know is that states where Medicaid expanded had higher rates of hospitalizations before the expansion. We know that the rate of increase has been faster in states that expanded Medicaid. We know that in states with Medicaid expansion hospital treatment for opioid issues will be paid for by Medicaid. Now we can say full stop.
The use of hospitalizations as your metric is problematic. What you really want to know is the incidence of abuse, and if that is increasing. Hospitalizations is just a proxy, and your priors should tell you that if a service that was not paid for is now being paid, the use of that service is likely to increase. I would have looked at other things also, or instead of this. Drug sales, arrest rates, narcan use, etc.
Steve
Fair enough, steve. The key point is that we don’t really know to what degree if any Medicaid expansion was a factor in increasing opioid abuse. It’s not a binary choice which is what the article would have.
True, but we do know enough to say that it was not solely Medicaid. You have the true Trump believers like Gray above who believe it was caused by Medicaid, so I guess the propaganda has worked. Even if you use only the somewhat flawed metric of hospitalizations, and agree it is going up a bit faster in Medicaid states, it is also increasing in non-Medicaid states, so you need an explanation for those states too.
Steve
I agree with that. My point was a narrow one: the only thing that the article rebutted was that Medicaid expansion was the sole cause of the opioid crisis.
True Believer? Yes, I think maybe I am. I think you will be someday too. You have to look past Trump’s shitty diction and thin skin to see that he really is good for this country.
And as for opioid abuse, it’s just not something I know, except from the news, and it’s bad.