Medicaid and the Opioid Crisis

 

There is an opioid crisis in America. That much is clear. Now we are learning what is contributing to this crisis.

Recent evidence is pointing the finger at the expansion of Medicaid. Senator Ron Johnson (R – WI) released a report this month from the Senate Homeland Security and Governmental Affairs Committee that connects the dots between Medicaid and the opioid epidemic. That’s the conclusion of the report as reported by The Wall Street Journal editorial board.

Contributing to this problem are several factors:

  • Too many opioid prescriptions – especially in the Medicaid population
  • Drug marketing – by pharmaceutical companies
  • Profits from the resale of opioids – on the black market

 

According to the Centers for Disease Control and Prevention (CDC), the opioid epidemic kills on average 115 Americans per day. About 40% of overdose deaths in the U.S. involve a prescription opioid.

Medicaid offers cheap access to astronomical quantities of pills that can be resold on the black market. For as little as a $1 co-pay, Medicaid beneficiaries can get up to 240 oxycodone pills that can be resold for $4,000, according to the report. Since 2010 more than 1,000 people across the country have been charged or convicted of improper use of Medicaid to obtain prescription opioids.

Where there is the potential for big profits, there is certain to be criminal behavior. The report gives case examples including a Connecticut drug dealer who “preyed on” Medicaid beneficiaries who were “down on their luck” according to a detective interviewed by the committee. The drug ring leader would pay Medicaid beneficiaries, say, $50 to get a prescription filled. Pharmacists tended to trust the Medicaid system and filled the scripts. Then the perpetrator would sell the opioids on the street for up to $3,000 for a single bottle. The perpetrator of this crime pleaded guilty to multiple charges in 2015.

This is just one small slice of the pie. The Johnson report discusses everything from a drug ring in the Bronx to a Maryland pharmacist charged with $90,000 in Medicaid fraud to a $1 billion fraud from a cabal of healthcare providers in Miami. A fictionalized story recently written by Michael Connelly, called Two Kinds of Truth, describes such drug activity in California by Mexican and Russian cartels based on real drug criminals who prey on Medicaid and Medicare patients.

The connection to Medicaid expansion is real. More than 80% of nearly 300 cases were filed in Medicaid expansion states. These include New York, Michigan, Louisiana, New Jersey and Ohio as the worst offenders. The report says,
“The number of criminal cases increased 55 percent in the first four years after Medicaid expansion, from 2014 -2017, compared to the four-year period before expansion.”

Clearly there is a problem here that is especially unique to the Medicaid population. It is apparent that criminals, including corrupt physicians and pharmacists, contribute to this problem by preying on those who are most vulnerable. Expanding the population of those covered by Medicaid has only expanded the opioid problem. We must find a better way to meet the healthcare needs of these low-income Americans without contributing to the opioid crisis.