A Wednesday hearing on the opioid crisis will examine whether Medicaid expansion has exacerbated the epidemic rather than helping to stem it.
The Senate Homeland Security and Governmental Affairs will host a hearing titled, "Unintended Consequences: Medicaid and the Opioid Epidemic." The committee's chairman, Ron Johnson (R., Wis.), has previously argued that Medicaid could be deepening the crisis.
Johnson, in a letter to the Health and Human Services inspector general last July, said his staff used public court databases and "identified 261 people who had been convicted—in states ranging from Pennsylvania to Vermont—of exploiting Medicaid cards to obtain opioids, which were often resold at enormous profit."
The letter stopped short of making a perfect link between Medicaid expansion and opioid abuse, but laid out evidence that Johnson believed established a strong correlation.
"Because opioids are so available and inexpensive through Medicaid, it appears that the program has created a perverse incentive for people to use opioids, sell them for large profits, and stay hooked," Johnson wrote. "I respectfully ask that the HHS [Inspector General] conduct a comprehensive review of controls in place to prevent the further abuse or improper use of the Medicaid program to obtain opioids."
Among the listed witnesses to appear at the hearing is Sam Adolphsen, former chief operating officer at Maine's Department of Health and Human Services.
Last year, Adolphsen penned an opinion piece for National Review that laid out Medicaid's role in the opioid crisis.
"While Medicaid may in some cases provide additional treatment options for an addict who is willing to engage, it also provides a 'free' plastic card loaded with unlimited government funds that often increases access to opioids," Adolphsen wrote.
The piece also cited a study from the U.S. Centers for Disease Control, which examined opioid abuse from 2004 to 2007.
"Although comparable prescribing data for Medicaid and non-Medicaid populations are not available for Washington, studies indicate that opioid prescribing rates among Medicaid enrollees are at least twofold higher than rates for persons with private insurance," the study said. But the report also cautioned that the higher prescribing rates could be due to Medicaid enrollees having, "a higher prevalence of substance abuse and other mental health problems."
Also at the witness table will be J. Otto Schalk, the Harrison County Prosecutor in Indiana. Schalk led the prosecution of an Indiana doctor who was investigated, "after the state received complaints from local pharmacies that [the doctor] was writing an unusually high number of narcotic prescriptions for Medicaid patients," according to news reports at the time of the doctor's arrest.
When Johnson wrote his letter to HHS in July, the politics were different, especially where Medicaid was concerned. At the time, Republicans were still working on efforts to reform the Affordable Care Act, which created Medicaid's expansion.
Numerous media reports at the time of those debates argued that preserving Medicaid expansion was necessary to quell the opioid crisis because it would offer more care to addicted patients who needed assistance in getting clean.