This morning, Sen. Ron Johnson held a hearing at his Homeland Security & Governmental Affairs Committee ostensibly to discuss the opioid epidemic. Instead, it quickly delved into a showing of right-wing talking points, falsely claiming that Medicaid expansion – ensuring more access to health care – is causing this epidemic.
What are the problems with this Republican theory?
CDC: “There Is No Evidence Medicaid Leads To Opioid Abuse.” “The Republican argument is flawed because the Medicaid expansion began in 2014, and opioid addiction was declared an epidemic by the Centers for Disease Control and Prevention in 2011. The federal science agency has also said there is no evidence that Medicaid leads to opioid abuse.” [Newsweek, 1/17/18]
Vox: “This Claim Runs Into A Basic Problem: The Concept Of Time.” “But this claim runs into a basic problem: the concept of time. Medicaid didn’t expand under Obamacare until 2014 — well after opioid overdose deaths started rising (in the late 1990s), after the Centers for Disease Control and Prevention in 2011 declared the crisis an epidemic, and as the crisis became more about illicit opioids, such as heroin and fentanyl, rather than conventional opioid painkillers. ‘It’s pretty ridiculous,’ Andrew Kolodny, an opioid policy expert at Brandeis University who’s scheduled to testify at the Senate hearing, told me.” [Vox, 1/17/18]
David Wyman, Georgetown University Law Center: “Just Because A Precedes B Doesn’t Mean That A Causes B. That’s Statistics 101.” “The witnesses included one anti-Medicaid ideologue, two local prosecutors who testified that they’ve seen a lot of addicts in their work and lots of them seem to be on Medicaid, and two experts who, tactlessly, pointed out that the causes of the opioid epidemic are many and complex, that it started years before Medicaid expansion, and that it involves patients and doctors in Medicare and private insurance as well as the uninsured… Efforts to demonize Medicaid expansion because it was launched as the opioid crisis really took off confuse correlation with causation, David Hyman of the Georgetown University Law Center warned Johnson’s committee. ‘Just because A precedes B doesn’t mean that A causes B,’ he said. ‘That’s statistics 101.’” [Los Angeles Times, 1/17/18]
Do Republicans pushing this theory have any actual evidence to back it up?
Washington Post: “They’ve Not Been Able To Prove Medicaid Actually Leads To Opioid Abuse. On The Contrary, [Medicaid Expansion] Has Given More Americans Access To Addiction Treatment.” “So, who’s right here? There’s little data to draw from, since Medicaid was expanded only recently under the ACA. But while conservatives have noted that overdose deaths are much higher among people inside the program than those outside it, according to the Centers for Disease Control and Prevention, they’ve not been able to prove Medicaid actually leads to opioid abuse. On the contrary, as Medicaid advocates note, expanding the program to include childless adults earning up to 133 percent of the federal poverty level has given more Americans access to addiction treatment. The program, which provided coverage to 3 in 10 people dealing with opioid addiction in 2015, covers outpatient treatment and inpatient detoxification, among other services, for substance use disorder.” [Washington Post, 1/17/18]
Could this theory lead to drastic conclusions which are squarely at odds with public health?
Katherine Baicker, University Of Chicago Harris School Of Public Policy Dean: “I Don’t Think Anybody Would Suggest Because Overprescribing Of Opioids Poses A Series Health Risk, People Shouldn’t Go See The Doctor.” “If [Republicans] argue against Medicaid based on the idea that it potentially allows more patients to get prescriptions for opioids, they could use that same reasoning to oppose expansion of private health insurance. Expanding health insurance of any variety increases people’s access to health care. Much of that care is beneficial; some may not be, Katherine Baicker, dean of the University of Chicago’s Harris School of Public Policy, told me. ‘I don’t think anybody would suggest because overprescribing of opioids poses a series health risk, people shouldn’t go see the doctor,’ Baicker said.” [Washington Post, 1/17/18]
What did the hearing accomplish?
Los Angeles Times: Wednesday’s Hearing “Showed How Threadbare [Republicans’] Arguments Are.” “The Republican campaign against Medicaid could only make the opioid crisis worse. That’s because Medicaid pays for a huge proportion of opioid treatments, covering fully one-third of those with addiction problems. Most of that spending is in expansion states — in fact, it’s possible that the prevalance of opioid addiction in some states may have helped prompt them to accept expansion (another example of how the relationship between addiction and Medicaid may have been misread). The necessity of continuing Medicaid expansion to address the opioid crisis was made forcibly by Ohio Gov. John Kasich and Arizona Gov. Doug Ducey, both Republicans, last year when congressional Republicans were working hard to eviscerate the program. Johnson and his fellow Republicans in Congress seem determined to impose cuts on the program, even though the benefits it renders are crystal-clear. Wednesday’s hearing did achieve one benefit, for all that: It showed how threadbare their arguments are.” [Los Angeles Times, 1/17/18]
Ultimately then, why did this hearing take place?
Newsweek: Sen. Johnson “Read An Article In Commentary, A Neoconservative Magazine.” “But in the end, even Senator Johnson acknowledged that the purpose of the hearing was a bit baffling. ‘People may be scratching their heads saying, ‘Why is Department of Homeland Security holding a hearing on the opioid crisis and Medicaid?’’ he said at the beginning of the meeting. He went on to explain that he had read an article in Commentary, a neoconservative magazine, that piqued his interest on the topic and asked his staff to compile a report and schedule a hearing on the topic.” [Newsweek, 1/17/18]
Most importantly, does this theory have the potential to cause significant damage to a population in urgent need of care?
Vox: “Republicans May Be In Fact Undermining A Potential Solution To The Overdose Crisis.” “Other evidence, meanwhile, suggests that Medicaid could actually act as a solution to the opioid crisis — because Medicaid, by expanding access to addiction treatment, could help stem the tide of addiction and overdose deaths. So by using this new hearing and report to potentially attack Medicaid, Republicans may be in fact undermining a potential solution to the overdose crisis.” [Vox, 1/17/18]
So there you have it. While millions of Americans struggle with the scourge of opioid addiction, and the White House leaves this epidemic in the hands of a lying, underqualified 24-year-old, Sen. Johnson continues to pontificate right-wing talking points he read in a magazine. Perhaps moving forward he’ll listen to the experts instead of pushing forward a false, ideologically-driven narrative that harms Americans.
