One of the most successful ways that’s been found to help people escape from opioid addiction is through medications that partially mimic the effect of more dangerous opioids while causing less intoxication and less physical dependence. Despite the success of these medications, a continuing stigma around their use means that health care providers are often wary. Oklahoma’s health care leaders aim to fix that, which is why several doctors’ groups and state officials recently hosted a training on appropriate use of these drugs. With heroin overdose deaths on the rise, their efforts should be applauded.
But reducing the stigma among health care providers is not enough when many Oklahomans can’t afford to see a doctor in the first place. A 30-day supply of one of these drugs, Suboxone, runs more than $350, and a year of treatment, including appointments and counseling, can cost upwards of $10,000. Oklahoma, with its second-highest non-elderly uninsured rate in the US and a severely underfunded health care safety net, still leaves many without access to treatment.
Mental health and substance abuse services are radically less accessible than other health services across the US, even for those with insurance. However, states that choose to expand Medicaid coverage still see significant improvements in access to treatment for low-income adults. A 2015 study found that expansion states saw a greater increase in the number of physicians supplying medications like Suboxone than did non-expansion states. Vermont used Affordable Care Act funds to kick-start addiction treatment infrastructure through the state. In Pennsylvania, which expanded coverage last year, nearly 1 in ten of those newly enrolled in Medicaid have sought treatment for drug and alcohol abuse. Three-quarters received services within two months of enrolling. Meanwhile hundreds of Oklahomans are stuck on a waiting list for substance abuse treatment.
As the graph above shows, Oklahoma spends less than half the national average per person on mental health and substance abuse services. Expanding coverage could change that. Instead, this spring, thousands of Oklahomans lost access to needed psychotherapy services as a result of midyear budget cuts. A year ago the killing of Labor Commissioner Mark Costello by his mentally ill son started a conversation about the need for better mental health treatment in Oklahoma. But despite all the talk, today we fund treatment even less. Even proven cost-saving measures like mental health and drug courts will be on the chopping block next if further cuts are made.
This is particularly tragic given the positive impact expanding coverage has on state budgets. A review of dozens of studies found an overall net positive economic impact for expansion, including state savings. The 2013 Leavitt Report, commissioned by the Governor’s office, estimated that expanding coverage would save the state Department of Mental Health and Substance Abuse Services more than $300 million over a decade – roughly equivalent to ODMHSAS’s annual appropriated budget. Furthermore, expanding Medicaid would strengthen hospitals and community health centers, thereby creating surer access to coverage for all Oklahomans.
Oklahoma’s substance abuse and mental health services are highly successful when they can be accessed. Reinvesting the savings garnered by Medicaid expansion into treatment – or prevention, where only 5 percent of state funding currently goes – could be a badly needed shot in the arm to the state’s mental health infrastructure. Expanded Suboxone use is one important tool. But so is Medicaid expansion, and with the second-highest incidence of adults with any mental illness and accumulating proof of Medicaid expansion’s effectiveness, it’s indefensible to leave it on the table.