Republican lawmakers are currently pursuing substantial spending cuts, raising concerns among critics who worry that such measures might lead to a reduction in Medicaid funds allocated to support Americans affected by the street fentanyl crisis. A report released by Democrats on the Congressional Joint Economic Committee highlighted the potential impact on over a million individuals in the U.S. who are currently receiving medical treatment for opioid addiction, including fentanyl.
Senator Maggie Hassan from New Hampshire, a Democrat, expressed concerns that proposals by former President Trump and Congressional Republicans to significantly reduce Medicaid funding to finance tax breaks for corporate interests and billionaires might threaten addiction care, especially as the country is beginning to make progress in addressing the fentanyl crisis.
Over the past decade, Medicaid has become a primary provider of insurance coverage for quality addiction treatment in the U.S., especially after several states expanded their Medicaid programs under the Affordable Care Act (ACA). A February study by the Brookings Institution revealed that nearly 90% of treatment for opioid and fentanyl addiction in the U.S. is at least partially funded through Medicaid. Richard Frank, the author of the study, noted the substantial increase in funding for substance use treatment due to the ACA.
Most drug policy experts concur that this funding has contributed to a reduction in drug overdose deaths, which reportedly decreased nationwide by 26.6% from June 2023 to October 2024, according to provisional data from the Centers for Disease Control and Prevention. However, the ACA remains a point of contention for some GOP lawmakers. While the specific effects of Republican budget proposals on Medicaid and its role in drug treatment are still unclear, some GOP leaders have suggested cutting up to $2.3 trillion from the program over the next decade.
House Budget Committee Chairman Jodey Arrington and House Speaker Mike Johnson have advocated for significant reductions to Medicaid, which the ACA expanded into a significant source of addiction treatment funding. During a recent appearance on Fox News, Speaker Johnson suggested that young men, who are particularly vulnerable to drug addiction and constitute a majority of overdose deaths in the U.S., should not qualify for Medicaid insurance. Johnson argued that able-bodied workers, such as young men, should not be part of the program.
Research indicates that men are two to three times more likely to die from drug overdoses than women, and fentanyl is now a leading cause of death for men under 50. Many addiction researchers, doctors, and individuals who have survived drug addiction are concerned that extensive cuts to Medicaid could disrupt the nation’s recovery from the fentanyl-overdose epidemic.
Keith Humphreys from Stanford University stated that it is difficult to envisage a scenario, given Republican budget plans, in which Medicaid is not drastically reduced, describing such a prospect as alarming. Dr. Brian Hurley, head of the American Society of Addiction Medicine, called on lawmakers to protect Medicaid expansion for those facing addiction, emphasizing its role in funding evidence-based addiction treatment and undermining drug cartels by reducing the demand for illicit opioids.
The Brookings Institution report concluded that a significant reduction in Medicaid expansion could drastically impair addiction care across the nation. The report highlighted that Medicaid payments for treating opioid use disorder (OUD) overshadow all other public funding sources for OUD care, and substantial cuts would diminish the nation’s economic commitment to addressing the opioid epidemic.
