Opinion

We can fight opioid abuse by expanding Medicaid

(AP Photo/Toby Talbot, File)
(AP Photo/Toby Talbot, File)

As the chief of police in the small town of Nashville, I’m on the front lines of North Carolina’s fight against the opioid epidemic every day. As this crisis has intensified and opioid overdoses have become a leading cause of death in our state, law enforcement officers have become crucial first responders. When North Carolinians overdose on opioids, police officers are so often among the first on the scene that many of us now carry naloxone, a drug that can help reverse opioid overdoses.

Coming face-to-face with this epidemic has shown me opioid use disorders can ensnare anyone. It is happening right here in our communities to families from all walks of life. Most people with opioid use disorders want badly to escape their substance use disorder, but breaking the bonds of opioid use disorder usually requires not only remarkable grit and resolve but also professional treatment.

Many people with opioid use disorders, however, do not have access to treatment that could save their lives, because they don’t have access to affordable health care. One of the most powerful tools for addressing the opioid epidemic is providing access to health care through affordable insurance coverage, both to people who already have opioid use disorders and those who are at-risk of developing disorders in the future. Coverage helps get those with substance use disorders into the health system, working with a doctor, and accessing treatment.

One in five adults with an opioid use disorder, however, is uninsured. Only 20 percent of uninsured people with opioid use disorders have received outpatient treatment in the past year, barely half the rate of those with insurance. Today, more than 900,000 working-age North Carolinians do not have health insurance.

Law enforcement officers often have to take people with opioid use disorders to jail when what they really need is treatment. Having these individuals in jail instead of in treatment is the wrong use of taxpayer dollars and an inefficient use of limited law enforcement time and resources.

How do we reduce the number of uninsured people and expand access to affordable health care? One thing many states have done is allow people who are in the “coverage gap” (who are uninsured but earn too little to qualify for subsidies to afford insurance on the individual market) to enroll in Medicaid. Thirty-three red and blue states now allow people in the coverage gap to enroll in Medicaid. Closing the coverage gap would give more than 400,000 people access to affordable health insurance, including up to 150,000 with opioid use disorders and other substance use or mental health needs.

Evidence shows that closing the coverage gap is essential to fighting the opioid crisis. After Ohio closed its coverage gap, 75 percent of previously uninsured individuals with opioid use disorders reported improved access to care. After Vice President Mike Pence closed the coverage gap when he was governor of Indiana, his Department of Health said, "a lack of health insurance was one of the first barriers to testing and treatment...[health insurance coverage] helped address that gap and opened door to medical care and treatment that have been life-changing."

Now is the time to act. The N.C. Medicaid program is strong and financially stable. Our neighbors in Virginia are currently negotiating a bipartisan bill to close their coverage gap. Health insurance can sometimes be a politically polarizing topic, but this is too urgent an issue for us to allow ourselves to retreat into ideological corners. Let’s all get together and figure out how to address this critical issue, and turn the tide on the opioid crisis ravaging our state.



Thomas Bashore is chief of police in Nashville, N.C.
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