Close the coverage gap to tackle North Carolina's opioid crisis

Every day, five North Carolinians die from an opioid overdose. Each death sends shock waves through a community: another friend, parent, or child lost to this ongoing crisis. Like the rest of the country, NC’s opioid crisis has only worsened during COVID-19. Unlike most of the rest of the country, however, NC has still not closed its health insurance coverage gap—meaning that people suffering from opioid use disorder (OUD) have much more difficulty accessing potentially life-saving treatment.

With health insurance coverage, people can better access and pay for counseling, medication, rehabilitation, and other services to help them beat OUD. Compared to the uninsured, people with Medicaid are nearly twice as likely to receive needed treatment. States that have closed their coverage gaps have already seen the positive impact on access to treatment, reporting an 18% drop in the number of people unable to access substance use services.

Research shows that medication is one of the most effective ways to treat OUD. But this medication can be expensive: one type, buprenorphine, costs $160 for a month’s supply. With health insurance, patients can ensure continued access to this medication for the time that they need to beat their disorder. Patients with health insurance are also more likely to receive medication when they enter a residential treatment facility, since the facility doesn’t risk picking up the cost. In fact, in states that closed their coverage gaps, residential treatment facilities were over 9 times as likely to use medication to treat OUD. Given the robust evidence around this medication’s effectiveness, this means that patients in these states receive higher-quality care.

Beyond improved substance use treatment, closing the coverage gap would increase access to healthcare in general, which could also help combat the opioid epidemic. OUD tends to go hand-in-hand with mental health disorders; nearly 70% of uninsured adults with OUD also report a mental illness. Therefore, this population requires greater access to comprehensive healthcare to address other mental health problems. Overall, some estimates suggest that closing the gap would help 150,000 North Carolinians with mental health or substance use disorders access affordable healthcare.

This increased access to treatment and other health services would impact the most tragic consequence of the opioid crisis: overdose deaths. States that closed their coverage gap saw a 6% decrease in deaths from opioid overdoses. After Ohio closed its coverage gap, Dayton—a city slightly larger than Wilmington which had one of the highest overdose rates in the country—saw deaths drop by over 50%. Closing the coverage gap isn’t just about OUD treatment: it’s about saving lives.

The proposed Build Back Better plan includes a temporary solution to NC’s coverage gap. While this policy would improve access to care, it would expire in 2025. A federal-level solution would also limit the economic benefits to NC while reducing NC’s flexibility to administer its own program. Thus, while a federal solution could be an important first step, it’s critical to continue to push for state-level action. 

For decades, the opioid epidemic has caused immeasurable loss. NC has poured money into addressing this epidemic for years, but we have not yet used one of the most important tools at our disposal: closing the health insurance coverage gap. With the recent pandemic-related spike in overdoses, now is the time to do everything we can to treat opioid use disorder and prevent future suffering.

Katie Horneffer is a Master of Public Health student at UNC-Chapel Hill and previous intern with Care4Carolina.