Public health emergency rings hollow

Medicaid cuts would deepen opioid crisis

PRESIDENT TRUMP’S ANNOUNCEMENT that the opioid epidemic is a public health emergency certainly drew attention to the problem, but in reality it is an empty declaration that, at least as of yet, provides no real resources to fight the epidemic.

The announcement will give the government more flexibility in the services that are made available to fight addiction, and the White House plans some type of public education campaign, but a problem that claims nearly 100 lives every day requires billions of dollars in funding, and no appropriation has been requested by the president.

The announcement seems to be more public relations than a public intervention. We need the latter and not the former.

Even worse than the lack of resources, though, is the fact that the policies championed by the White House will definitively worsen the epidemic, not alleviate it.

The proposed major cuts to Medicaid that the Trump administration has sought to advance through passage of House and Senate “repeal and replace” bills would severely deepen the crisis, as will the loss of insurance subsidies for people who otherwise cannot afford health insurance.

When people lose health insurance coverage and they can no longer get regular medical care and prescription medication, they self-medicate using illegal drugs. The same is true when people go without dental care and live with the pain of abscessed and damaged teeth. A lack of health coverage perpetuates addiction.

Medicaid has been on the leading edge of battling the opioid epidemic and is responsible for covering roughly 30 percent of the cost of caring for people with opioid addiction. To cut Medicaid, as Trump has proposed in dramatic fashion, is to cut the funding available to treat addiction.

It is also important to note that Medicaid is covering the cost of treating addiction for some of the most complex cases, and without Medicaid there would be no agency or organization to pick up the slack.

Substance abuse and addiction are intertwined with mental health care. Detox is the first step in treatment, but unless it is followed up by intensive rehabilitation – including therapy – to address the causes of addiction, individuals are highly likely to return to drug use. People on Medicaid can get access to these services currently, but that access will be limited or eliminated as states have to dial back the expansion that has brought Medicaid to more lower-income individuals.

The Trump administration has made such a concerted effort to shift responsibility for Medicaid and other programs to the states. It is a way to limit federal involvement and funding under the guise of letting states innovate.

Some of the states hardest hit by the opioid epidemic, such as those in the Northeast, are the innovators when it comes to solutions to the epidemic, so the administration should find a way to fund these most promising models. But because the Trump public health emergency declaration has no funding attached to it, this is not possible.

The administration’s plan is simplistic in the way that it makes public education and advertising an anchor. Such advertising efforts have never demonstrated a high level of success because telling someone not to get started with drugs cannot compare to the personal, emotional, and financial struggles that lead people to get involved with drugs. Like so many other initiatives from this administration, it shows a true lack of understanding and empathy for the struggles of everyday Americans.

It has taken President Trump 10 months to develop a plan for a problem that is truly a national scourge. What the administration has brought to the table is a series of initiatives at the margins, rather than real weapons to combat the problem.

Just as concerning as the lack of resources is the cognitive dissonance on display where the administration states it is going to war on both Medicaid spending and opioid addiction. You can’t do both at the same time because Medicaid is too critical to the effort of battling addiction.

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Public policy issues are deeply interwoven. Cutting in one area often creates a bigger problem downstream. Trump’s insistence in attacking Medicaid and the ACA while declaring opioid addiction a public health emergency is yet another example of how this president and administration truly do not understand how government works. With close to 100 people dying every day from overdoses in coffee shop bathrooms, on street corners, and in public parks, they don’t have much time left to learn.

 Gerard A. Vitti is the founder and CEO of Healthcare Financial, Inc. in Quincy.