Did Obamacare’s Expansion of Medicaid Contribute to the Opioid Crisis in North Dakota and Elsewhere?


Back during their 2013 session North Dakota lawmakers voted to expand the state’s Medicaid program in accordance with Obamacare despite a Supreme Court ruling declaring any federal retribution for failing to pass that expansion to be unconstitutional.

Former Governor Jack Dalrymple, though vocally opposed to Obamacare, was the fourth Republican governor to support the expansion. It became effective in January 2014. Current Governor Doug Burgum supported keeping the expansion upon coming into office and lawmakers obliged him during their session earlier this year.

But did that expansion contribute to North Dakota’s opioid crisis? “Medicaid patients may be more likely to be prescribed opioids—twice as likely, according to two studies, as privately insured individuals,” Allysia Finley reports for the Wall Street Journal. “A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015.”

Finley points out that the rise in overdose deaths in states which expanded Medicaid was twice as fast as states which did not. In North Dakota, specifically, there is a very strong correlation between a spike in opioid overdose deaths and the expansion of Medicaid:

…government health-care programs are among the biggest suppliers of prescription painkillers. The attorneys general ought to be investigating how Medicaid may help promote opiate abuse and addiction.

Wisconsin Sen. Ron Johnson this summer highlighted a correlation between the ObamaCare Medicaid expansion and opioid overdoses. Data from the Centers for Disease Control and Prevention show that overdose deaths per capita rose twice as much on average between 2013 and 2015 in states that expanded Medicaid than those that didn’t—for example, 205% in North Dakota, which expanded Medicaid, vs. 18% in South Dakota, which didn’t. That’s particularly striking since the energy boom boosted North Dakota’s economy and employment.

To be fair, this is correlation. And correlation is not necessarily causation.

Still, there’s a creepy sort of logic here.

In North Dakota doctors and hospitals get paid for patients on Medicaid about the same as patients on Medicare according to the Kaiser Family Foundation, but Medicare pays significantly less than private insurance. On average, doctors get only 80 percent of what they charge private insurers for Medicare patients.

My point is that there might be a cost incentive for doctors to treat Medicaid (and Medicare) patients in a less rigorous fashion than those they can charge more, which might mean prescribing more opioids.

I’m making a lot of assumptions, and I’m sure the medical community would vehemently deny any difference in treatment between Medicaid/Medicare patients and others, but how else to explain such a distinct correlation between opioid problems and the expansion of government health care programs?