Gov. John Bel Edwards' Medicaid expansion could lead Louisiana directly into the eye of a perfect storm. The expansion of the entitlement program under Obamacare has complicated our state's opioid crisis. It could not have happened at a less opportune time, coinciding with the scheduled release of more than 1,500 prisoners next week thanks to criminal justice reform.
Edwards' expansion dramatically increased the number of Medicaid opioid prescriptions in Louisiana. Before the expansion, Medicaid paid for more than 500,000 opioid prescriptions. Now the program pays for more than 900,000 according to Louisiana Attorney General Jeff Landry. That's almost a doubling in a little more than a year. We can't know for sure how many new opioid users that represents. Some might have previously used the drug before Medicaid expansion and paid for it themselves. But if you subscribe to the principle that giving something away increases its use, then it's a safe bet a whole lot of new folks in Louisiana are now on opioids.
The Center for Disease Control reports half of all opioid overdose deaths come from those with a legal prescription. Users often know how to game the system by doctor swapping. Eventually, the CDC says, many addicts transition to buying heroin on the streets illegally. That's when the opioid problem becomes a crime problem. Medicaid recipients nationally are two times as likely to overdose on opioid as those with private insurance, according to the CDC. In the state of Washington, it's even more dramatic, where someone on Medicaid is almost six times as likely to die from an opioid-related death. I'm not aware of such available data specific to Louisiana.
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Landry believes the increase in the availability of free opioids, along with the potential early release of more prisoners, eventually will significantly increase crime. Others in Louisiana's law enforcement community have expressed similar reservations.
It should be noted that Louisiana's criminal justice reform legislation had support from some conservative groups, many in the business community, and both Democrats and Republicans. That support was based on criminal justice reform measures in place in Texas and other states. But Landry says the legislation in Texas was much more comprehensive in approach and paid for rehabilitation services up front. That's something he says the Louisiana legislation does not do. Releasing prisoners without necessary rehabilitation services, combined with greater access to prescribed opioids under Medicaid expansion has Landry very concerned.
Landry says one way to curb the abuse of opioids is to crack down on Medicaid fraud and abuse. Landry requested more money to investigate Medicaid fraud and abuse. He wanted 19 new investigators but says the governor gave him only 10.
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Expansion means one-third of Louisiana's population is now on Medicaid. The state's Medicaid budget for this fiscal year is $12.5 billion. Five years ago it was $7.7 billion. With that many extra billions floating around, fraud and abuse is a given. There's another reason to suspect Medicaid fraud and abuse. Louisiana has more opioid prescriptions than it has people. Louisiana saw 108 opioid prescriptions for every 100 people, based on figures from 2012 according to the Centers for Disease Control.
Three out of four heroin users began with opioids. For the first time last year, New Orleans saw more deaths from accidental drug deaths than murder. Baton Rouge has also seen record levels of overdoses linked to heroin and opioids.The correlation between drug use and crime is without dispute.
It's also true a small group of people commit the majority of crime. Beginning in November, a larger percentage of that small group will hit the streets as a result of criminal justice reform. Most of them will end up on Medicaid and presumably have greater access to prescribed opioids. Hold onto to your hats, folks. Things could get bumpy.
Dan Fagan, a former TV and radio broadcaster who lives in Metairie, writes a column that appears Wednesdays and Sundays. Email him at firstname.lastname@example.org.