How Medicaid Cups can endanger American progress against opioid dependence

While she heads for the hilly streets of Asheville, in North Carolina, Brandi Hayes is moved by the memory of a father whom she barely knew.
In part of the 5-year-old post-sur-Surdose response team in the region (port), it takes place towards emergency calls in a vehicle belonging to the county. With each rescue attempt, she remembers the death of her own father following a heroin overdose at 27 years old.
The work of Ms. Hayes, like port efforts, does not stop at calls for 911. The team of four units follows within 72 hours to provide support, education, advice and a link with care. Since Medicaid pays most opioid treatments here, the government’s low -income insurance program is complex linked to the port mission.
Why we wrote this
Americans want to help fight drug addiction, within the limits. Medicaid cuts, which supports many drug treatment programs, may have community repercussions nationally.
“Medicaid is a large part of what we do,” she says.
Now, while the Republicans move to limit the expenses of Medicaid – in the hope of slowing down the government and compensating for the tax reductions proposed – efforts to process opioids like those here in Asheville are confronted with an uncertain future. This is part of a broader controversy around the law on One Big Beautiful Bill, now approaching final approval at the Congress. Even among the Republicans, the Medicaid cuts cause tensions in the midst of forecasts that millions of Americans could become uninsured.
Mousing admissibility changes to Medicaid arrive at a “tenuous moment” for the opioid crisis, according to KFF, a non -profit organization which provides non -support reports on national health policy. Almost two thirds of people with dependence on opioids looking for treatment are on Medicaid, he says.
Some 71 million Americans are currently registered in Medicaid, according to recent government data. The proposed modifications could lead to the non-payment of nearly 12 million people more during the next decade. Expenditure discounts of up to $ 1 billion, according to criticism, are used to extend the tax advantages to companies and households earning more than $ 200,000 per year.
“You may be wondering, if they are generally poor white men who die from drug overdoses, why this administration, which is built on the back of white male voters with low education, abandoned something that works?” said David Herzberg, co-author of “Whiteout: how racial capitalism has changed the color of opioids in America”.
Opioid epidemic has contributed to more than 100,000 overdose deaths in the United States in 2022, according to the centers for Disease Control and Prevention, with some 7 million Americans who have a certain form of opioid consumption disorder, whether it is a prescription, a fentanyl or heroin.
Progress in the reduction of deaths by overdose
But last year, these deaths by overdose dropped from 27% nationally and a similar amount here in North Carolina, a sign encouraging front -line workers like Ms. Hayes.
In addition to the port’s response and the enveloping services, the decline, she says, is the result of a myriad of factors, including community saturation of anti-surdosage drugs, the expansion of the treatment assisted by drugs, the worsening of the quality of heavy street drugs thanks to the forces of prohibition and hesitation by many to imply in the opions granted to the Palissanism overdose that affected their communities.
The Trump administration has focused on a range of strategies, including border security where drugs have been tampered with, promoting medical interventions and disturbing the world’s fentanyl pipeline, the opioid behind the point of overdose.
“We are going to take measures to continue to love and cherish Medicare and Medicaid programs to ensure that they are preserved for those who need it most,” explains an executive decree of June 6 signed by President Donald Trump who refers to the elderly as the main beneficiaries of Medicaid on whom he concentrates. (While the elderly are covered by health insurance, many also turn to Medicaid due to low incomes.)
For adults of the working age, the versions of the Senate and the bill of the bill include an obligation of work, volunteering or to study 80 hours per month to qualify for registration, except if they have an exception.
Eligibility by the bill exempts those who suffer from drug addiction disorders looking for treatment. But there are major concerns about other eligibility and report requirements for people with drug problems, if federal cuts will lead states to reduce payments to treatment providers and the impact of rural hospitals, which have been the main concern for Holdout Republicans like the North Caroline Thom Tillis senator.
Residents of conservative rural areas are often more likely to qualify for Medicaid. But obtaining assistance for drug addiction can often be difficult because some conservative states limit the type of prescriptions that can be used for processing, as well as available services.
“Medicaid is a big, if not the biggest, the player and a huge factor in the way people with the abuse of opioid abuse get care,” explains Joshua Lynch, professor of emergency medicine and dependence at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences in New York. “Reducing access to care after a year in which deaths have been reduced is absolutely not the right answer. The opioid epidemic continues to evolve, and we must change our response. ”
The way in which cocaine had an impact on black predominantly urban districts in the 1990s, dependence on opioids and bulldosis by rural America, mainly affecting young adults and white men of average age.
But in the past 15 years, overdose deaths among American racial minorities, including from the use of opioids, have accelerated the fastest, the mortality rate in American blacks increasing by 249% between 1999 and 2022.
A problem of public concern – with the limits
Although drug use has generally been considered a problem for poor urban communities, Americans have become more and more sympathetic to opioid users looking for care. Three out of 10 say they or a family member have been dependent on opioids.
And it’s not just a problem for Democrats. More than half of the Republicans (55%) oppose the major reductions in the current Medicaid program. Senator Josh Hawley, a Missouri republican, described the Medicaid rules proposed “morally erroneous and politically suicidal”, saying that the cuts would alienate the voters of the working class.
But there is a limit to this concern.
Representative Nicole Maliotakis of New York, a first republican criticism of Medicaid discounts, recently told CNN that she had changed their mind and now supported the cuts because they target “people in the country illegally” and “people who refuse” to meet the work requirements.
The attitudes about who should receive help can change according to historical models and if the “favored groups” are those who suffer, explains Professor Herzberg, a historian also at the University of Buffalo.
Places like Asheville, a green and vibrant city that some inhabitants consider it to be an “oasis” for drug use, are part of the test fields.
From 2010 through the COVVI-19 pandemic, Asheville and the County of surrounding Buncombe saw a wave of overdose death linked to fentanyl, with about half of them being also tested. The other half came from all socioeconomic horizons. According to the Coroner Bureau of North Carolina, those who died were catering employees, a dance instructor, a jeweler and a border patrol agent.
This toll fueled a local response, which exploited a recovery culture in Asheville. Government institutions have adopted misdeed reduction programs by punitive programs. The sheriff has been elected partly on its plan to provide treatment assisted by drugs – which can half overdose death – to imprisoned people. The subscription of many of these costs was, once again, Medicaid.
Yon Goldblatt, one who recovers from an addiction to methamphetamine and who is homeless and who lives in Asheville, says that Medicaid put it on the path of recovery.
But he understands how many Americans become impatient to help people who do not seem willing – or capable – to help themselves. “It’s like saving someone from drowning and then watching them jump in the water,” said the old massage therapist.
Professor Herzberg offers a different reading. For him, an effective strategy is like drawing a drowning on the surface, then freeing them only after having had the chance to breathe.
Medicaid cuts, he says, could compromise ready -to -use resources for places affected by drug addiction like Asheville to help them develop – and provide – harm reduction programs, fentanyl test strips and other drug deterrents.
“We have this continuum in the United States where the reduction of misdeeds is really respected and in other places, this is not the case,” said Professor Lynch, a former emergency medical technician. “You can bring people to a recovery path. Or you can say: “Tormous. You don’t get anything. »»
While Mrs. Hayes and her team meet in a grocery store, she salutes a shirtless man and acts it. His name is Shawn Vannernick, and he was his father’s best friend. Mr. Vannernick says he has been dependent on methamphetamine for a long time. But he attributes to the port of Ms. Hayes for having helped him request a treatment funded by Medicaid.
“There is no doubt,” he said with a brilliant smile. “Their efforts are paid.”




