September 20, 2017
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Medicaid is a critical tool in the fight against opioid addiction. New reforms could weaken it.

By Darrell Crandall and Michael Gahagan, Special to the BDN
George Danby | BDN
George Danby | BDN

People who’ve become addicted to opioids often tell troubling stories about debilitating physical symptoms, the loss of jobs and homes, and an inability to care for their kids and other people who are important to them.

In some cases, they even become involved in criminal activity that threatens the stability of both families and communities. When that happens, the costs are staggering — each year opioid addiction costs society an additional $1.5 billion in police protection, $726 million in adjudication, and $625 million in property loss.

For these reasons and more, this is a significant issue for those of us in law enforcement — one we simply cannot arrest our way out of. Based on ample research and our professional experience, we know that effective treatment is crucial for getting people back on track for productive lives.

That brings us to both good and bad news. On the upside, Congress last year passed the 21 st Century CURES Act, which provides $1 billion in grants to enable states to address opioid abuse. On the downside, comprehensive health care legislation now being considered by Congress — the American Health Care Act — threatens the stability of our state’s Medicaid program, which provides health insurance to about 273,000 people in Maine and nationally covers three out of every 10 people who are addicted to opioids. In its current structure, the federal government pays 64 percent of the cost of covering each person enrolled in our state’s Medicaid program, also known as MaineCare. This structure allows the program to respond when our state has dire health needs, such as the opioid addiction crisis or those arising from a natural disaster.

But the American Health Care Act would set a “per-capita cap” for federal Medicaid funding based on how much it cost to cover individuals in 2016, and states would be at full financial risk for any spending above the cap. There would be no increase if more people enrolled who would need access to a new, expensive treatment, therapy or prescription drugs. That could be particularly difficult for law enforcement if the opioid addiction becomes more severe over time, and more problematic for everyone who would be affected by any unforeseen health emergency.

The bottom line, according to the Urban Institute, is that the proposed per capita cap as it stands would ultimately reduce federal Medicaid funding in Maine by $1 billion between 2019 and 2028.

With few options for additional federal support, many people simply won’t receive the medical care they need.

These challenges are especially relevant to Maine’s rural counties, which have the highest percentages of residents who rely on MaineCare. They’re also a problem for rural hospitals, which already spend more than $30 million per year on uncompensated care. If people lose Medicaid coverage and become uninsured, they will seek care in emergency rooms, which will raise the costs of uncompensated care even more, thereby threatening the ability of these hospitals to remain open.

As members of the nonpartisan organization, Fight Crime: Invest in Kids, we’re compelled to make two very important points regarding the impact of Medicaid cuts on young people. First, we need to recognize that children need parents who provide strong and thoughtful guidance in their kids’ lives. Without treatment, many moms and dads struggling with opioid addiction won’t be up to the job — we therefore feel very strongly that ensured funding for treatment is a smart step for parental responsibility.

Second, we need to recognize that cuts to Medicaid will have an indisputably negative impact on kids in a more direct way. Right now, MaineCare and the state Children’s Health Insurance Program cover more than 130,000 kids. Thirty-eight percent of these children live in rural areas. The fact that they’re receiving coverage is good news to everyone who wants kids to become self-sufficient adults. Research by Georgetown University shows children who are enrolled in Medicaid are more successful academically, more likely to graduate from high school, and more apt to be healthy adults who earn higher wages.

All of which brings us to our bottom-line message: coverage for everyone from individuals struggling to overcome addiction to those who simply want to stay healthy has a direct connection to public safety and taxpayer savings. As Congress considers Medicaid reform, we want to ensure that Maine’s lawmakers and residents have the resources we need to build healthy families and communities for years to come.

Darrell Crandall is the Aroostook County sheriff, and Michael Gahagan is the Caribou chief of police.

 


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