Thursday, January 18, 2018

PolitiFact Florida: No evidence Medicaid expansion is fueling the opioid crisis

As Floridaís lawmakers grapple with the opioid crisis, one U.S. representative claims thereís a correlation between states that expanded Medicaid through Obamacare and states affected the worst by the epidemic.

Republican U.S. Rep. Matt Gaetz, R-Fort Walton Beach, shared this factoid on Twitter on Oct. 17: "Opioid crisis the worst in ObamaCare expansion states!"

Gaetzís claim quoted a Tucker Carlson tweet that questioned if "big pharma" is responsible for Congressí inaction toward the opioid crisis.

Information supplied by Gaetzís office rests on the notion that patients in states that expanded Medicaid through Obamacare have more access to legal prescriptions that fuel the opioid epidemic. Experts said the theory ignores critical facts and does not take into account the other factors that have led to an increase in opioid deaths.

"It is important to avoid confusing association with causation," said David A. Fiellin, a professor of medicine at Yale School of Medicine. "Just because one event (Medicaid expansion) occurred during a period of increasing opioid deaths, many from illicit sources doesnít mean that it caused the increase in deaths."

Thirty-two states plus Washington, D.C., currently have adopted Medicaid benefits to all adults. The expansion for most states went into effect in January 2014. The time frame matters because the most recent data is from 2015, meaning thereís not a lot of data to work with.

In 2015, the five states with the highest rates of death due to drug overdose were West Virginia, New Hampshire, Kentucky, Ohio and Rhode Island, according to the Centers for Disease Control. All of those states expanded Medicaid.

But thereís little evidence Medicaid expansion is the reason why. Many researchers, for instance, have noted that the overdose death rates were higher to begin with in those states.

Richard Frank, a professor of Health Economics in the Department of Health Care Policy at Harvard Medical School sent PolitiFact Florida a research memo he co-wrote on the issue.

Data he compiled from the CDC showed that the states that expanded Medicaid were experiencing higher levels of deaths due to opioids than non-expansion since 2010.

"The opioid epidemic had already hit those states hardest before the ACA even passed and well before the expansions were implemented," the memo said.

Vanderbilt University economist Andrew Goodman-Bacon and Harvardís Emma Sandoe posit that other factors, including the opioid epidemic itself, led states to adopt the ACA Medicaid expansion in their look on the issue.

"A state with rapidly rising opioid deaths may have decided to expand Medicaid in order to provide drug treatment to more residents," the pair wrote.

Frank and his colleague found another problem with the Medicaid theory. The memo said since 2013, nearly all the increases in opioid overdoses in the United States are due to heroin and synthetic heroin substitutes.

In other words, it treats all drug overdoses the same. The data Gaetz cited from the CDC includes prescription and illicit drugs. Medicaid coverage does not provide access to illicit drugs.

Data from the CDC shows that since about 2010 the number of deaths from commonly prescribed opiates has not fluctuated one way or another. In contrast, opioid deaths from heroin and other opioids, such as Fentanyl, have increased dramatically in that same time period.

"A significant portion of the increase in deaths was due to deaths involving synthetic opioids other than methadone, which includes Fentanyl," the CDC says.

Gaetzís team also cited the CDC Morbidity and Mortality Weekly Report, which said: "opioid prescribing rates among Medicaid enrollees are at least twofold higher than rates for persons with private insurance."

But the data they cited was last updated in 2009, so Gaetzís evidence was before the Affordable Care Act had even passed. This argument is common among individuals who believe Medicaid makes drug abuse worse, but itís not accurate, according to the Goodman-Bacon and Sandone analysis.

"Medicaid patients, especially those who qualify through a disability and many who do not, are more likely to have chronic conditions and comorbidities that require pain relief," the duo wrote.

Lastly, itís worth noting that Medicaid expansion helps pay for opioid addiction treatment, said Brendan Saloner of Johns Hopkins Bloomberg School of Public Health. Medicaid expansion covers costs treatments like detoxification, outpatient treatment, and treatment for masked health conditions.

So Gaetz is isolating on one yearís worth of data that, by itself, is flawed and experts were universal in saying that the evidence that Medicaid expansion is somehow fueling the opioid crisis doesnít exist. In some ways, itís not much different than saying that the opioid crisis is worst in states in the eastern time zone. You wouldnít blame a clock.

We rate this claim Mostly False.

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