Expanding Health Coverage is Key to Addressing Opioids and Substance Use Disorders


The opioid crisis and challenges with other substance use disorders have had devastating effects on families and communities across Texas and the nation in recent years. Drug overdose deaths rose by over 7 percent in 2016 alone, many due to opioids. And the leading cause of maternal mortality in Texas is drug overdose, with the Panhandle and Dallas/Fort Worth regions facing the greatest risk of maternal death due to overdose. Texarkana, Amarillo, Odessa, and Longview are among the 25 American cities with the highest opioid abuse rates, but every corner of the state faces substance use challenges. Substance use disorders, when not addressed, add significant costs to our state budget in terms of health care, public safety, criminal justice, domestic violence, and foster care. Overdose deaths, CPS removals of kids from parents struggling with addiction, and other tragic results have spurred state leaders to action, with both the Texas House and Senate holding hearings on the subject this year to prepare for the next legislative session.

To address this crisis, state leaders must make sure Texans with substance use disorders have access to effective treatments, like residential treatment, counseling, medication-assisted treatment, and long-term recovery supports. The results have been positive when coverage is available to connect Texans with treatment services. For example, Texas Medicaid began covering treatment in 2011 for the small number of Texas adults who are eligible for the insurance program. Summarizing the data on the new substance use disorder benefit, CPPP wrote:

A November 2017 report by HHSC shows that adding the benefit did not increase the per-person cost of Medicaid services for people with an SUD diagnosis. More importantly the limited data on outcomes show meaningful improvements in people’s lives in terms of decreased homelessness, decreased arrests, and increased employment. Although it is hard to draw a direct link between access to SUD treatment services and improved outcomes, it is definitely a contributing factor.

Unfortunately, many Texans with substance use disorders do not have insurance and therefore have significant trouble accessing substance use treatment and recovery services. According to the U.S. Department of Health and Human Services, in a given year about one million Texas adults face mental illness or a substance use disorder without the benefit of health insurance. 

Those uninsured Texans are left with few, if any, options for treatment and a path to recovery. Limited federal block grants help fund community-based substance use providers, which offer treatment to a small proportion of low-income, uninsured Texans. These safety-net programs are stretched thin and significant unmet needs remain. In fact, community-based substance use providers were able to serve only 5.8 percent of uninsured, low-income Texas adults with a substance use disorder in 2017. Lack of insurance coverage, and with it, the inability to afford treatment, creates an insurmountable barrier for many uninsured individuals in need of substance use disorder care. 

In other words, one of the most important steps state leaders can take to address the opioid crisis and substance use disorders is to ensure that more Texans have access to health insurance that covers substance use treatment and recovery supports. Unfortunately, Texas has the highest uninsured rate and highest number of uninsured residents in the nation — with 4.5 million or 16.6 percent of Texans without health insurance.

Under Medicaid policies set by the Legislature, low-income workers in Texas generally do not have access to health insurance. Many construction workers, cooks, child care workers, and other low-wage workers don’t receive insurance from their employers and don’t make enough to buy insurance. They also miss out on insurance if they stay home to take care of a baby or other family members while their spouse works in one of these low-wage sectors. In states that have accepted Medicaid expansion funding from the federal government, those workers can enroll in health insurance through Medicaid. However, Texas leaders have not accepted the Medicaid expansion funds yet, meaning that for the most part the only low-wage Texas workers that can enroll in Medicaid health insurance are seniors, pregnant women, and Texans with severe disabilities or near-death illnesses. The U.S. Department of Health and Human Services reports that a huge number of Texans with mental illness or substance use disorders could be insured if Texas accepted the Medicaid expansion funding (about 400,000 of the one million uninsured Texas adults with mental illness or substance use disorders would be covered.)

Texas voters have also made clear that they want the Legislature to work on this issue. In a recent poll, 87 percent said it was a “top priority” or “important” for the Legislature to work on improving access to health insurance.

To effectively address substance use disorders in Texas, and in order to address many of the other challenges facing the state, Texas leaders must work on a plan to reduce the state’s high uninsured rate and connect more low-wage workers with insurance.


Take Action

Email our state leaders and urge them to expand health coverage in Texas.