When Kim, a grandmother in recovery, moved to North Carolina to be closer to her son in 2018, she initially had difficulties filling her buprenorphine (Suboxone) prescription because her provider could no longer prescribe her medication across state lines.
“Using Suboxone has greatly helped me not only be free of drugs and alcohol for the whole time being here, but it’s my livelihood,” Kim, who is using her first name only for privacy reasons, told Salon in a phone interview. “I can’t function without it — and I’ve tried.”
In the 20 years that Kim has been using buprenorphine, there have been several times where changes in her life, like her move, or changes in policy have abruptly cut her off from her medication. She has been able to access treatment through Medicaid, the health insurance program for low-income Americans, uninterrupted for the past couple of years. But she worries that budget cuts being debated by Republicans could take that away.
“This saved my life… and it can save a lot more,” Kim said. “I don't understand why you would try to take it from people.”
"It’s time to double down on all of the things that have been working, not reverse them."
Medications like buprenorphine and methadone are considered the gold standard for treating addiction, according to decades of research, because they can reduce deaths as well as improve social functionality. Increased access to these drugs is thought to be a major factor contributing to the first significant reduction in national overdose deaths to occur since 2018. Although 87,000 Americans still died from overdoses in 2024, a decline of 24% from the previous year, many are concerned this progress could be lost, especially if the federal government makes significant cuts to Medicaid.
“It’s time to double down on all of the things that have been working, not reverse them,” said Stephanie Strong, co-founder and CEO of Boulder Care, a telehealth addiction treatment center. “That’s what I fear will happen if people lose their health benefits.”
President Donald Trump has promised to cut between $1.5 and $2 trillion from the federal budget in the next decade. Although he has said he will not cut Medicaid, Senate Republicans have been debating whether to overhaul the program.
Some are skeptical that the administration will cut Medicaid significantly, but an analysis performed by The Congressional Budget Office earlier this month found that it would be impossible to find enough cuts elsewhere that do not affect Medicaid in some way.
Medicaid, the largest source of insurance for addiction treatment, has demonstrably saved lives and improved access for many people seeking addiction treatment. In one 2020 study, Medicaid expansions were associated with between 1,678 and 8,132 lives saved from an overdose between 2015 and 2017. Another 2021 study found admissions for addiction treatment were 36% in states that had expanded Medicaid four years after the expansion compared to ones that had not.
“Probably the single biggest policy-level change that has benefited addiction treatment has been guaranteeing Medicaid and Medicare coverage for medical treatment of addiction with methadone and buprenorphine,” Dr. Ryan Marino, an emergency medicine physician at Case Western Reserve University School of Medicine, told Salon. “More people are certainly able to access evidence-based treatment, and lives have been saved.”
Trump’s stance on drug policy seems to largely be focused on the criminalization of drugs rather than treating the overdose crisis like a public health issue, which experts say is not as effective in stemming the overdose crisis. Trump has said that he issued high tariffs on Mexico, Canada and China because “they’ve allowed fentanyl to come into our country at levels never seen before” and has even threatened war with drug cartels. But this week, the Trump administration also extended an emergency declaration to address the national opioid crisis, first declared in 2017, which allows for some expedited decisions to be made related to substance use disorder treatments.
Still, if the Trump administration does cut Medicaid funding, regions in which its constituents live could be hardest hit by the decision. In West Virginia and Tennessee, for example, two states where Trump won the vote in the 2024 election, upwards of 20% of the population is on Medicaid. And these two states have some of the highest rates of per-capita overdose deaths in the country.
Medicaid funding not only expands access to medication-assisted treatment like buprenorphine and methadone, but also funds things like group or individual therapy as well as programs that help people find employment and other aspects of recovery in certain states, said Dr. Elizabeth Stone, who researches health services and policy at Rutgers University.
“Recovery is an ongoing process and for people who are stabilized with medication for opioid-use disorder or are seeing their therapist regularly, losing insurance coverage can be a really high-risk time for harm,” Stone told Salon in a phone interview. “Downstream, then you’re also potentially having people even less likely to access care than they already are now.”
If Medicaid access is reduced, Kim worries about the time it would take to switch over to another insurance, if she could even find one she could afford.
"Losing insurance coverage can be a really high-risk time for harm."
“That would be days or weeks from getting any kind of insurance, and if you are sick and going through withdrawals, you’re not going to wait,” Kim said. “You’re going to go and do whatever you can to get to feeling better.”
Policies that cut Medicaid might include taking away coverage from people who don’t meet certain work requirements or limiting payments given to states, pushing the states to make the cuts.
But cutting work requirements, for example, has been tried by some states without success. In Arkansas, a temporary program with these requirements led to the loss of coverage for thousands of people but did not increase employment.
“My perspective is that they're not actually effective in reducing the number of people who are eligible for Medicaid, they just create more hoops and ultimately, more costs and administrative waste,” Strong told Salon in a phone interview. “[We need to be] making sure the resources are going to the right places, and leveraging technology and telemedicine to offer care that's lower cost and more available in rural areas, rather than investing in building more facilities and more beds.”
Nevertheless, whether potential cuts to Medicaid funding would in fact cut costs is unclear. Like with any medicine, reducing access to treatments used for addiction can make people seek care when they have more health care needs, which ends up costing more money. In one 2021 analysis, all forms of medication-assisted treatment (buprenorphine, methadone and naltrexone) were associated with up to $100,000 in lifetime cost savings per person compared to people who were not treated.
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Additionally, because the Centers for Medicare and Medicaid Services covers such a large portion of the population, the center can often negotiate drug prices to be lower, which affects the market and can benefit people on other insurances, Marino said.
“They're saying that they're saving us money by doing these cuts, but there are very few things that are as cost-effective as Medicare and Medicaid,” Marino said. “Not only because of the kind of preventable health benefit and downstream economic benefits, but also because CMS can negotiate down the prices of drugs, and even people who are on private insurance then get benefits.”
Some hospitals and treatment centers are also dependent on reimbursements from CMS, so even a small cut in Medicaid could affect their funding and lead to shutdowns, Marino said.
“That is going to impact not only people who are in addiction treatment,” Marino said. “If the closest hospitals shut down and you now have to drive 30 minutes away when you’re having a stroke or a heart attack or someone is overdosing, that is going to lead to a lot of additional problems.”
These decisions are expected to be made in mid-2025, when Congress faces a deadline for passing Trump’s agenda. For now, the close to 4.9 million people using Medicaid for addiction treatment will have to wait and see if they are impacted.
“We’re trying to get ourselves better and we’re trying to be drug-free,” Kim said. “I would hope that the government could see that.”
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