Medicaid unwinding may hamper nation's opioid response

Photo by Donavon Smallwood, The New York Times

About 4 million Americans have been taken off the Medicaid rolls this year, and millions more will follow, which could unintentionally slow the national effort to stem opioid overdoses and deaths, report Daniel Payne and Megan Messerly of Politico. "Millions of Americans are likely to lose their Medicaid as Covid-era protections unwind, and while some will find health insurance through Obamacare or their employer, many will become uninsured or underinsured. That has public health and addiction treatment experts concerned that opioid abuse — responsible for over 80,000 deaths in 2021 — is about to spike."

Robin Williams, a professor of psychiatry and chief medical officer at opioid use disorder treatment provider Ophelia, told Politico, "I'd say it's a sleeper issue that people in the industry and the sector have been very worried about for years … but now it's happening. I think it's easy to overlook unless you're really close to it." Payne and Messerly report: "People with opioid use disorder are disproportionately covered by Medicaid, according to claims and enrollment data. The historic change in coverage could have an outsized impact on the overdose crisis, particularly as new, especially lethal drug cocktails — such as fentanyl mixed with xylazine — become more prevalent."

Experts estimate that 15 million people could lose health insurance coverage during the transition. The timing is not ideal for the Biden administration or the country's opioid response. "Polling shows opioids are among Democrats' and Republican's top health concerns, and a majority of Americans disapprove of President Joe Biden's performance and think Congress should do more," Politico reports. "[The changes] could derail treatment plans for the most vulnerable patients being treated for opioid use disorder. . . . Some doctors have seen patients who stopped taking opioids during the pandemic return to them after their coverage changes because they can no longer afford therapies that were working."

Opioids were responsible for more than 80,000 deaths in 2021, "profoundly affecting nearly every state and district nationwide," Payne and Messerly add. "The Biden administration has been focused on guiding states through the redetermination process—pushing for all eligible Americans to remain enrolled. . . . State health officials have expressed concern about the impact of redetermination on overdose rates, with some identifying grants that can pay for treatment when some people inevitably lose coverage. . . . Federal officials share that concern, and the Biden administration's National Institute on Drug Abuse is prioritizing research on the implications of the Medicaid redetermination process on the 
opioid epidemic."