States watch health care debate closely as opioid crisis grows

Rooting out fraud and tighter reporting play key roles in the fight against addiction

BRIAN SNYDER—Reuters
From left to right: North Carolina Gov. Roy Cooper

PROVIDENCE, R.I. — North Carolina Gov. Roy Cooper was among Democrat and Republican governors to urge Congress to consider the opioid drug addiction crisis when contemplating changes to Medicaid in the health care debate.Governors meeting in Rhode Island warned that many residents of their states were relying on Medicaid to get treatment for opioid addiction, which grips an estimated 3 million Americans and killed 33,000 people in the United States in 2015, according to federal data.On Monday night the health care replacement bill proposed by Senate Republicans last week, called the Better Care Reconciliation Act, failed to be scheduled for a vote as four Republican senators said they could no support its phase out of Medicaid expansion. The bill included more than $45 billion for fighting the opioid addiction epidemic, which would have been distributed directly to states in the form of grants for addiction treatment programs along with addiction and pain research.The proposal gradually scaled back federal funding for Medicaid expansion found in the Affordable Care Act (ACA), commonly called Obamacare. It also changes Medicaid from an open-ended entitlement program to a fixed, per-head amount paid to states with states retaining more control over how it is spent. Now, with no Senate plan on the table, Senate leadership say they will push to repeal Obamacare now and replace it later.The governors meeting in Providence warned that as lawmakers plan to tackle a soaring federal deficit ($440 billion in the 2018 fiscal year) and escalating entitlement costs ($2.5 trillion in the 2018 fiscal year) that opioid addiction treatment in many states flows through Medicaid. In N.C. more than 21 percent of prescriptions for buprenorphine, an addiction recovery medication, are paid for by Medicaid.”We’re kidding ourselves if we don’t think what’s happening with health care in Congress right now is affecting this issue,” Cooper told his counterparts at a meeting of the National Governors Association. “We cannot have millions of Americans lose their health coverage and still effectively attack this crisis. We can’t significantly reduce Medicaid spending and still be successful in fighting opioid addiction.”At least one Republican governor at the meeting, Chris Sununu of New Hampshire, shared Cooper’s concerns, saying lawmakers should get local buy-in on how states will be affected by any proposed changes to Medicaid.”The first version made very severe cuts to Medicaid and some other programs that would have had a very significant impact to our state. It’s one of the main reasons I came out against it,” Sununu said in a brief interview.”They have to solicit the input from those of us governors, mayors, county commissioners, all the way down,” he added. “Those of us who are implementing these programs are the ones that really understand the impact.”In N.C. total Medicaid spending is growing, now at more than $12 billion. Medicaid accounts for approximately $3.4 billion, or 16 percent, of the total state budget. The most recent budget, vetoed by Cooper in June but overridden by the General Assembly, also includes $2 million for an opioid treatment pilot program and $100,000 for naloxone kits, an overdose reversal drug, for law enforcement officers.However, according to state lawmakers and N.C. Attorney General Josh Stein, it’s going to take more than just money to fight opioid addiction, which kills three people a day in N.C.The STOP Act, passed unanimously by the General Assembly, signed by Cooper and supported by Stein, restricts opioid prescriptions to no more than a five-day supply. The restriction would not apply to cancer patients or those suffering from chronic pain. It also requires providers to participate in a statewide reporting system to prevent patients from “doctor shopping” for more pain killers.Federal and state government is also cracking down on Medicaid fraud as a way to stem escalating costs. On Thursday the U.S. Justice Department announced that more than 400 people, including doctors and nurses, have been charged with defrauding Medicaid, Medicare and other federal health care programs of $1.3 billion, with many accused of illegally distributing opioids and other narcotics. The federal Department of Health and Human Services and N.C.’s Medicaid Fraud Control Unit assisted in the investigations.A total of 412 people, including more than 100 doctors, nurses and other medical professionals, have been charged in the sweeping enforcement action, the biggest ever by the multiagency Medicare Strike Force, the Justice Department said in a statement.”Health care fraud is not only a criminal act that costs billions of taxpayer dollars, it is an affront to all Americans who rely on our national health care programs for access to critical health care services and a violation of trust,” said DHHS Secretary Tom Price.In many cases, health care providers paid cash kickbacks to patients and others in exchange for medical data that would allow them to file fraudulent bills to Medicare, the Justice Department said.Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 3,500 defendants who collectively have falsely billed the Medicare program for more than $12.5 billion.