I see the Federal government has allowed states to place work requirements on Medicaid recipients. Kentucky’s the first state to take advantage of the new rules, with others soon to follow. The Governor justified it as follows: “Why should a working-age person not be expected to do something in exchange for what they are provided?”
I can’t help seeing that as a moral (and political) argument rather than a medical one. And not very practical, either. I wish he’d save it for some future time when we’re no longer in the midst of an opioid epidemic (let’s hope that time comes).
The problem: Requiring proof of employment for indigent people to qualify for healthcare is likely to drive opioid addicts away from help — when the goal should be to attract them to it.
Why? Let’s say you live in a community that’s threatened by escalating opioid use. Actually, there’s a good chance you do. Naturally, you want government to do whatever’s best to minimize the adverse effects of opioid addiction on your community. These are serious and fall into three broad categories:
- Overdose— the most attention-getting. I’m referring to both fatal and non-fatal OD. The first is a tragic waste of life, leaving grieving families in its wake. The second is a major drain on limited resources, especially for law enforcement and healthcare.
- Drug-related crime— property crime, burglary, theft, home invasion, etc, but also sales and trafficking, gang activity, and violence. It’s the stuff you read about in the headlines.
- Community health— HIV/AIDS transmission, sexually transmitted disease, hepatitis, blood borne illnesses. All this represents major new stress on limited healthcare resources. Who pays the bill? We do.
In other words, government must act not just for the benefit of the opioid user, but for the benefit of the larger community. Who among us wants to live and work and raise a family in the midst of a drug epidemic?
Fortunately we know, based on years of experience, that simply enrolling addicts in affordable treatment options is the “low-hanging fruit” of successful intervention. We make it easy for opioid users to get medications that help break the cycle of drug use and minimize relapse. This can be done on an outpatient basis, and it’s waayyy cheaper than a hospital bed or a jail cell. It’s just a far better return on investment for the taxpayer.
In short, we strive to make sure that treatment services are:
- Available — we have enough treatment slots to meet the need
- Convenient to transportation, and
- Financially accessible. We don’t want to turn people away because they can’t pay.
We’re the beneficiaries. Our communities are better places to live, because of what we do to manage the scourge of addiction in an effective, and cost-effective, manner.
Now: If our goal is to get more users into treatment without delay, we shouldn’t place unneeded barriers in their way — such as insisting they maintain employment as a condition of health benefits that allow them to access treatment. We should focus on engaging them in treatment first, knowing that once they are, they might actually be able to get and keep a job.
Frankly, it makes perfect sense to me. But then, I’m not a politician.
