Glum news for the Volunteer State was released last week by the federal Centers for Disease Control and Prevention: Despite a decline in overdose deaths in surrounding states, Tennessee’s continued to rise in 2018.
According to CDC numbers, 1,837 people died in Tennessee from drug overdoses in 2018, and another 89 people died of suspected overdoses that couldn’t be confirmed by toxicology tests. Even without the suspected numbers, that’s a 3% increase over 2017, which held the record to that point for the highest number of overdoses.
Nationwide, overdoses fell more than 4% in 2018, yet Tennessee remains an outlier. Kentucky, West Virginia, Ohio, Pennsylvania: all states hit hardest by the ongoing opioid epidemic saw rates drop, but not Tennessee. The reason for Tennessee’s continued increase baffles state officials, including epidemiologist Dr. Tim Jones, who told The Tennessean newspaper “We will take any good ideas, from anywhere, as to how to help stop this.”
One suggestion? Expanding access to Medicaid. Under the Obama administration, Tennessee was one of 14 states that refused to pursue it; under Trump, Republican lawmakers are seeking lump-sum block payments to fund Medicaid — administered in Tennessee through the TennCare program — but critics argue that states would receive less federal funding under the block grant approach, which would lead to officials being forced to slash benefits and enrollments.
In a time when Medicaid has been shown to play an instrumental role in fighting the opioid epidemic, that would be disastrous. The Kaiser Family Foundation, a leading resource for health journalism and health policy analysis, released an extensive report in May of this year that said as much. Based on 2017 figures, in which almost 2 million adult suffered from an addiction to opioids and four in 10 of those had Medicaid coverage, the organization found that those with Medicaid were more likely than those with other coverage to have received substance abuse treatment.
As someone who now works full time in the addiction treatment field, I can speak with authority to the fact that the crisis is getting worse, and the resources to help those afflicted are shrinking. Addicts and alcoholics aren’t exactly flush with cash or robust health insurance policies anyway, and that’s reflected in the number of overall individuals who needed substance abuse treatment in 2017 vs. those who actually received it: According to key findings from the 2017 National Survey on Drug Use and Health, an estimated 20.7 million people needed rehab for all drugs and alcohol combined (not just opioids). How many actually got it? Less than a fifth of that number (4 million people). According to the survey, 1 in 3 of those who didn’t get help “had no health care coverage and were not able to afford the cost.”
Going back to that Kaiser Family Foundation report, “those who had Medicaid were twice as likely as those with private insurance to have received drug and/or alcohol treatment.” There are a number of reasons for that, but it comes down to the fact that private health insurance plans aren’t nearly as robust as we’d like to think. Between the two facilities under the Cornerstone of Recovery umbrella, Cornerstone is targeted toward individuals with private insurance. Our sister facility, Stepping Stone to Recovery (both are located in Blount County), accepts TennCare, or Tennessee Medicaid, patients.
While everyone receives some coverage, the fluctuating nature of health insurance — the requirements for prior authorization, the caps on behavioral health benefits, the push for therapeutic shortcuts to keep costs down — means that private insurance patients often go through treatment under a cloud of concern, wondering when a reviewer at the company will decide they’ve had “enough” treatment and cut off coverage. Medicaid patients often fare better because their treatment is mandated by certain federal regulations and oversight.
Regardless, the Medicaid expansion offered under the Affordable Care Act, which Tennessee opted not to pursue, can have an impact. According to the Kaiser Foundation, “states that have not yet adopted the ACA’s Medicaid expansion can improve access to treatment by expanding Medicaid, which would enable them to cover many people with OUD (opioid use disorder) who are currently uninsured.”
Unfortunately, the ACA is also known as Obamacare, which is a political football that many Republican politicians — who hold a majority in Tennessee — want nothing to do with. That’s a tragedy, considering how more and more of their constituents are dying every year because of drugs. At this point, it would seem that they, too, would be willing to accept “any good ideas,” and until they are, I’m afraid we’ll see those numbers continue to rise.