Medicaid cuts may put addiction treatment out of reach

Aug 01, 2023

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By Erin Schumaker and Daniel Payne

Presented by

With Alice Miranda Ollstein

Driving the Day

An arrangement of pills of the opioid oxycodone-acetaminophen

Medicaid cuts could slow opioid-crisis progress by hobbling the nation's opioid response. | Patrick Sison/AP Photo

ONE CRISIS TO ANOTHER — Medicaid redetermination may make for a sizable setback in the progress against the opioid epidemic, Daniel and our Megan Messerly report.

The changes in coverage for millions of Americans, already underway, could derail treatment plans for the most vulnerable patients being treated for opioid use disorder, providers and public health experts told POLITICO.

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.

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.

And that potential loss of progress in the opioid crisis comes at a delicate time for Washington.

— Opioids were responsible for more than 80,000 deaths in 2021, profoundly affecting nearly every state and district nationwide. That’s led Congress to move more urgently to find policies to solve the problem.

— And 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.

“I expect we’re going to see a lot of disruption over the next year,“ said Dr. Brian Hurley, medical director of the Division of Substance Abuse Prevention and Control for the Los Angeles County Department of Public Health and president-elect of the American Society of Addiction Medicine. “Any time that there’s any kind of these transitions, it puts people at risk.”

WELCOME TO TUESDAY PULSE, where even cacti can’t take this summer’s heat. We just learned that Arizona’s saguaro cacti are losing their iconic arms during the state’s record streak of hot temperatures. Send tips, feedback and advice for keeping cool to eschumaker@politico.com and dpayne@politico.com.

TODAY ON OUR PULSE CHECK PODCAST, host Ben Leonard talks with Daniel, who takes a deeper dive into why public health experts fear an uptick of opioid overdoses as pandemic protections expire and Medicaid unwinds.

Listen to today’s Pulse Check podcast

A message from PhRMA:

Insurance isn’t working like it should. 53% of insured Americans say they can’t anticipate what they’ll pay for health care services, even if those services are covered by their insurance plan. Learn more about the cost and coverage barriers Americans face. 

Public Health

A woman's hands on her pregnant belly

Abortion bans, a shortage of obstetrics units and loss of health coverage could make it difficult for pregnant women to access needed care. | Ulises Ruiz/AFP via Getty Images

WORSENING MATERNAL HEALTH ACCESS — New data from the nonpartisan health advocacy group March of Dimes shows that the U.S. — which has the worst maternal mortality rate among developed nations — saw a 4 percent decline in hospitals with labor and delivery services between 2019 and 2020.

Access to care is also likely to worsen in the coming years, according to several public health experts, as obstetrics units struggle to stay financially afloat, more people become uninsured and new anti-abortion laws limit the number of doctors willing to practice in several states.

The new report comes as births are expected to rise in states with strict abortion bans, further stretching the remaining services in those regions.

The crisis by the numbers:

— About 5.6 million women live in counties with no access to maternity care.

— 32 million women are at risk of poor health outcomes because of a lack of nearby care options.

— More than a third of all U.S. counties are considered maternal care deserts, with no access to reproductive health services.

— In 2021, roughly 33 people died for every 100,000 live births in the U.S., according to the CDC, up 40 percent from 2020. That’s roughly 10 times the mortality rate of other industrialized nations such as Australia, Germany, Japan and Spain.

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Covid

COVID’S ‘NEW NORMAL’ — Despite rising Covid-19 hospitalizations, public health experts and the White House appear confident heading into fall, David Lim reports. While it’s the first rise in hospitalizations since early 2023, weekly hospitalizations remain near an all-time low.

“To some extent, I’m thinking of this as the new normal,” Association of Public Health Laboratories CEO Scott Becker said. “We never expected variants to just disappear, so the virus is doing what viruses do. We’re watching all of this in order to better be prepared for any fall surge in respiratory diseases.”

Akin Demehin, senior director of quality and patient safety at the American Hospital Association, said Covid isn’t straining health care systems like it did during the first three years of the pandemic.

“This likely reflects the fact that most individuals have at least some degree of immunity conferred from vaccination, prior Covid-19 infection, or both, along with the broad availability of treatments that significantly reduce the likelihood of needing an [emergency department] visit or hospital admission for Covid-19,” Demehin said.

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In the Courts

AG SUED OVER ABORTION ENFORCEMENT THREATS — Two health care providers and an abortion fund are suing Alabama Attorney General Steve Marshall over his threats to charge anyone who aids and abets an out-of-state abortion, arguing that it’s infringing on their First Amendment right to discuss options with pregnant people who come to them for advice.

The federal lawsuits filed at the U.S. District Court for the Middle District of Alabama in Montgomery seek to block Marshall from bringing charges in the future against the Yellowhammer Fund, the West Alabama Women’s Center and the Alabama Women’s Center — all of which provided or funded abortions before Roe v. Wade was overturned and now focus on other forms of reproductive health care.

The groups say the AG’s threat — which he has yet to carry out — has caused a chilling effect, preventing them from providing referrals and information about how to obtain an abortion in a state where it’s legal to do so.

Alice profiled the legal and financial threats facing these groups in POLITICO Magazine in May.

“Attorney General Marshall will continue to vigorously enforce Alabama laws protecting unborn life which include the Human Life Protection Act. That includes abortion providers conspiring to violate the Act,” the attorney general’s office said in a statement to POLITICO.

At the Agencies

AT LONG LAST, A LONG COVID OFFICE — The Biden administration’s proposal last year to start an office devoted to long Covid is now a reality.

Health and Human Services Secretary Xavier Becerra announced the Office of Long Covid Research and Practice on Monday to lead the government’s response to long Covid — which affects between 7.7 and 23 million Americans.

The National Institutes of Health will also launch long Covid clinical trials, as part of the RECOVER initiative, according to HHS. The $1.15 billion research initiative is tasked with learning why some people have lingering symptoms after their acute infection has passed — and figuring out how to treat them.

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Names in the News

Dr. Robert Steinbrook is the new director of Public Citizen’s health research group. He was previously editor-at-large at JAMA Internal Medicine.

Jonathan Campbell is the new chief science officer at the National Pharmaceutical Council. Michael Pratt is the NPC's new chief communications officer.

Privia Health has elected David Wichmann and Pamela Kimmet to its board of directors.

What We're Reading

The Washington Post reports on how a renowned fertility doctor profited from an untested supplement.

New York Magazine reports on how the author of The Body Keeps the Score helped make trauma a popular American diagnosis.

A message from PhRMA:

Insurance isn’t working like it should. The latest Patient Experience Survey uncovers the challenges insured Americans face affording care and how practices by health insurers and middlemen put patients at risk. Learn more.