Is the expansion of Medicaid also driving opioid usage? According to the NY Times, it does. Obamacare achieved its goals by having fewer people uninsured, while adding greatly to the Medicaid rolls in the USA. There are four major types of insurance that people in the USA have Medicaid - Those whose income is below 2,250 for an individual in NJ, and this amount can vary depending on the state. Medicare - people 65 and older are eligible. Many people have also purchased a Medicare supplement which is from a private insurer or have decided on a Medicare replacement plan which is also known as part c, which allows them to use their Medicare with a private commercial carrier. Private Commercial Insurance - includes most major insurers. 50% of those insured in the USA through a major carrier are actually self insured through large employer groups. The VA (Veterans Administration System) which includes Tricare - For army personnel. Historically, the expansion of Medicaid has been lauded as a success, with private commercial carriers administrating the program in different states. A recent story that the NY Times reported on suggested that Vermont, West Virginia, Kentucky, Montana and Ohio which were states with the highest usage of the prescription drug, buprenorphine which reduces the craving associated with opioid dependence. In 2013, another Medicaid carrier, Partnership Health plan of California had noticed that statistically, any area where there insured's were concentrated were also problem areas with opioids. Most areas that had Medicaid had poor access to chiropractic care for chronic pain, and primary doctors routinely recommended opioid usage. Partnership health plan responded and initially had doctors recommend alternative medications for pain and then added chiropractic management from the money saved from the rising prices of the opioid medications. What they found is that areas that were served by the chiropractic community were much less likely to use opioids for pain relief and that their overall costs for chronic pain decreased. Some carriers such as Optum, a third party administrator owned by United Healthcare, have begun to realize that using a chiropractic approach instead of medication not only yields better results for pain, but their overall costs are reduced. While on the surface, it may seem obvious that the opioid crisis was due to overzealous drug manufacturers such as Johnson and Johnson who recently were fined hundreds of millions of dollars for their activities, and more recently Perdue Pharmaceuticals which was owned by the Sackler family and was given a 12 billion settlement. The problem is systemic and could not have happened in any state without the help of organized medicine, insurance carriers who continue to have financial barriers that affect chiropractic patients and large hospital systems that own medical practices and employ few chiropractors. Is Medicaid the problem, or is a lack of access to chiropractic and appropriate reimbursement to these highly qualified experts in the musculoskeletal system actually driving those costs. If we look at the experience of Partnership Health Plan, chiropractic offers a proven profession who reduce pain naturally, and reduce the dependence of patients on pain medications. While the problem with opioid addiction and chronic pain is larger than just Medicaid, the truth is, chiropractors save on costs by understanding why patients hurt, and use methods such as myofascial release, manipulation, exercise and mobility to help their patients. This is supported by the medical literature and chiropractors have the highest levels of satisfaction for chronic pain when compared to physical therapy, and medical management. Currently, there is a bill pending in congress to improve access to chiropractic care known as the Chiropractic Modernization act of 2019. The bill would allow chiropractors to practice and be reimbursed under the full scope of their state practice. This would improve the availability to lower cost chiropractic treatment to many of our elderly clients, while decreasing their dependence on medications too. There is currently a program that is ongoing in Connecticut, which uses Federal Qualified Health Centers, clinics that treat Medicaid patients. All doctors are paid the same for the time allotted, and are paid well. These centers are using chiropractors and are getting great results with problems such as back pain and chronic pain. There are other models that work as well, however, without integration of chiropractors in Medicaid systems, drugs are likely to continue to be a huge problem. For chronic pain; all roads lead to chiropractic.