Op-Ed

Why doesn’t North Carolina’s Opioid Action Plan consider Medicaid expansion?

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The surge in overdose deaths from opioids and other drugs has dominated the local, state and national spotlight for several years now and resulted in task forces, advisory councils, committees, commissions and work groups convened by the General Assembly and elected officials. Sadly, the most critical and obvious solution to effectively addressing the opioid epidemic in a meaningful and sustainable way has been rejected time and again by our General Assembly since 2013.

Medicaid expansion offers the single most effectiveway to provide health insurance coverage to an estimated 500,000 people in our state, paving a way for them to access care and treatment. Without it, our state will continue to suffer thousands of preventable and unnecessary deaths.

North Carolina had the second-highest increase in the nation of overdose deaths in 2017. In that year alone, there were more than 5,000 visits to emergency rooms due to overdoses. Roughly 50 percent of the overdose survivors were uninsured. The vast majority of people who use substances cite an inability to pay for treatment due to a lack of insurance.

Rejecting Medicaid expansion not only poses barriers to care, but it also adversely affects our hospitals, particularly rural ones that are forced to act as a safety net for uninsured people. Since the legislature’s decision to reject Medicaid expansion, our state has seen five rural hospitals shutter their doors.

People who want treatment but can’t get it due to lack of insurance aren’t only using hospital ERs, they’re also crowding our state prisons.

Data from the Department of Public Safety show that of the 17,366 inmates screened, a staggering 71 percent reported they needed intermediate or long-term substance use disorder treatment. Our state prisons are not equipped to provide care and treatment people need. Only half of inmates have a chance at being placed in an intermediate program and the odds are even worse for long-term programs, with only one in six getting placed.

The lack of a meaningful long-term solution to address overdose and chaotic drug use has also strained our state’s foster care system, which has been impacted by parental substance use. This has critical consequences for the future as drug use is often intergenerational and the trauma of being separated from family can have future effects on the likelihood of substance use.

While the rapid response teams that have been mobilized by the state legislature to visit people after they overdose can play a part in reducing or preventing future overdoses, they are temporary fixes that are only guaranteed to be around for one or two years due to funding constraints. What people really need to get linked into care or treatment are long-term, stable programs that can ensure coverage for that care.

Linking people to care or treatment when they decide they want it is the most effective way to reduce overdoses, particularly when it’s medication-assisted treatment (MAT), which has the highest rates of success. Yet hundreds of thousands of people in our state are in the “coverage gap,” meaning they earn too much to qualify for Medicaid as it is now, but not enough to receive a subsidy through the Affordable Care Act Marketplace.

Our state’s Opioid Action Plan for 2017-2021 declares that “expanding treatment and recovery systems of care” is one of the primary strategies for addressing the opioid epidemic. But how effective is it to expand treatment and recovery without ensuring that people have a means to actually pay for those services?

In other states that have expanded Medicaid, treatment for substance use disorder has been one of the most utilized health care services. Kentucky had a whopping 700 percent increase in Medicaid beneficiaries accessing treatment for substance use disorder. A recent study shows that Medicaid expansion states had an 18 percent increase in admissions for opioid treatment facilities, largely due to a 113 percent uptick in Medicaid beneficiaries receiving MAT.

Our General Assembly’s decision to continually reject Medicaid expansion not only exacerbates the opioid epidemic and is detrimental for future generations, but it also means that we’re losing out on billions of federal dollars that can spur economic growth and job creation.

It’s time to put politics aside and come together for a real solution to the opioid epidemic. Close the coverage gap. Expand Medicaid. No more excuses.

Jesse Bennett is the Statewide Overdose Prevention Coordinator for the North Carolina Harm Reduction Coalition. Donald McDonald is the Executive Director of Addiction Professionals of North Carolina.
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