How to Exacerbate Arizona's Opioid Epidemic? Dismantle Medicaid

Arizona’s campaign to end a surge in opioid deaths could collide with Republican efforts to scuttle the Affordable Care Act and enact huge cuts to Medicaid.

The Better Care Reconciliation Act was unveiled last week to a flurry of opposition after it was drafted in secret by Senate Republicans. Arizona health care and medical associations joined in, criticizing the bill. They say drastic reductions to the state’s expanded Medicaid program could hamstring efforts to fight an opioid epidemic that killed, on average, more than two people per day last year.

Last week alone, there were 191 suspected opioid overdoses reported by the state Department of Health Services; 15 people died. On the department’s website, bright-red statistics tick upward to show the alarming weekly count of statewide overdoses and deaths.

In a June 22 statement, Greg Vigdor, the president and CEO of the Arizona Hospital and Health Care Association, called the Senate bill “a drag on Arizona’s fight against opioid abuse.”

“The nearly $1 trillion in Medicaid cuts envisioned by this legislation will undermine the war on opioid abuse and put more of our neighbors, friends and families at-risk,” Vigdor said.

Governor Doug Ducey, a Republican, declared a state of emergency on June 5 and directed the Department of Health Services to immediately respond to the epidemic of opioid deaths. Last year, Arizona saw 790 deaths from opioid overdoses, according to the state’s Department of Health Services. Deaths from opioid overdoses in the state have surged by 74 percent over the past four years.

Arizona’s Medicaid program, the Arizona Health Care Cost Containment System, forecasts phased-out federal funding by 2024 for the 400,000 Arizonans who receive coverage under the Affordable Care Act’s expansion of Medicaid.

This population at risk of losing their health insurance includes about 16,000 adults with a primary diagnosis of Opioid Use Disorder.

All told, the Senate bill would increase costs for Arizona by $7.1 billion from 2018 to 2026, the agency predicted. Nationwide, the bill would take an axe to Medicaid, slashing about $772 billion over the next decade while slowing the program’s spending growth rate down the road, according to a Congressional Budget Office analysis.

The deep cuts in funding to AHCCHS would certainly impact the 16,000 adults in Arizona with a primary diagnosis of Opioid Use Disorder, according to the Arizona Medical Association.

“We cannot tackle important issues like the opioid epidemic if people do not have access to full health care coverage,” the association’s executive vice president, Chic Older, said in a statement to Phoenix New Times.

The association is encouraging members to voice their opposition to the Senate legislation.

On Tuesday, Senate Majority Leader Mitch McConnell postponed a vote on the bill to replace the Affordable Care Act, or Obamacare, until after the July 4 recess.

Ducey has described Obamacare as "a monumental failure and a rolling disaster." But he refrained from embracing the bill as written by Senate Republicans, expressing reservations in a letter to Sen. John McCain last week. A spokesman for the governor did not respond to a request for comment.

Ultimately, criticism from Republican governors may have caused Senate Majority Leader Mitch McConnell to postpone the vote.

In his letter to McCain, Ducey wrote, “Medicaid must be able to pay for the real-world costs of providing care." McCain seemed to be receptive. After the vote was postponed, McCain said he plans to address Ducey’s concerns about the bill’s impact on Medicaid in Arizona.

On the extreme right, the Senate legislation also had trouble finding support. Ultraconservative Rep. Andy Biggs, a Republican representing Arizona’s Fifth Congressional District, said the Senate bill doesn’t go far enough to dismantle Obamacare.

“I am extremely disappointed by the lack of resolve from Congress to repeal Obamacare – most recently, with the U.S. Senate’s legislation,” the member of the intransigent Freedom Caucus wrote in a press release. “The American people demanded a full repeal.”

Partisan fireworks notwithstanding, the opioid crisis will continue to take a deadly toll on Arizona. Will Humble, the executive director for the Arizona Public Health Association and the former director of the state's Department of Health Services, said rolling back Medicaid will hamper the treatment front of any fight against opioid drug abuse.

“The Senate and House bills aim to restrict and squeeze Medicaid programs, including Arizona’s, and fewer people will qualify over time and the care will reduce over time,” he told New Times.

Although he emphasized the importance of access to care via Medicaid, Humble added that long-term success against opioid addiction will require policy development and regulations that encompass the scope of health care institutions, outpatient treatment clinics and prescription practices.

“You can’t just keep catching people at the end of the pipeline,” Humble said.