Burcum: ‘Why would we make it harder to get help’ for addiction?

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For more than a half century, Project Turnabout has helped those struggling with drug and alcohol addiction in southwest Minnesota. In recent years, the Granite Falls-based provider has been on the front lines in the fight against a public health scourge: overdose deaths from opioid prescription painkillers.

Remarkable strides have been made recently with drug overdose deaths dropping nationally and in Minnesota. Unfortunately, Project Turnabout’s CEO and executive director Marti Paulson is now sounding an alarm about a threat to this progress: historic cuts to the Medicaid program that Congress is considering.

Medicaid is a public program covering low-income people. It is the nation’s largest payer of behavioral health services and substance use disorder treatment. At Project Turnabout, Paulson estimates that only 1 out of 5 clients could access treatment without public program assistance.

Without this help, “the amount of use is going to skyrocket and we will see overdose deaths rise up again,” Paulson said. “Even though we’ve seen a reduction in the amount of overdose deaths, we have not seen a reduction in the need for treatment at all.”

The noble work done by Project Turnabout and other specialists has played a critical role in the fight against substance use disorder. But to Paulson’s point, the work is far from over.

Minnesota data underscores KFF’s point, that deaths remain at high levels despite recent progress.

In 2023, the state saw its first decline in five years in the number of opioid-involved overdose deaths, the Minnesota Department of Health reports. There were 1,011 such deaths that year, down from 1,039 in 2022. Five years before, however, there were 349 fatal opioid-involved overdoses.

The goal shouldn’t be just to return to that lower number but go well under it, which will take time and resources. It’s difficult to see how that happens if the Medicaid cuts take effect.

“Federal cuts to Medicaid and critical behavioral health programs, just as we are getting our arms around the opioid and overdose crisis, will have significant consequences on our ability to keep people alive, find recovery and lead the kind of purpose-filled lives that benefit every community across Minnesota,” said Jeremy Drucker, director of the state’s Office of Addiction and Recovery.

Sen. Amy Klobuchar is also warning about the cuts’ consequences.

“We cannot turn back the clock.”

More details on the proposed Medicaid reductions were released over the past week by congressional Republicans.

Earlier this year, a U.S. House Republican budget resolution set a savings target of $880 billion (spread over 10 years) for the committee overseeing Medicaid. Annual spending on the program: $872 billion.

That House budget framework didn’t specify Medicaid cuts to help offset the cost of President Donald Trump’s proposed tax cuts. But the committee was left with little choice but to find savings in the Medicaid program.

House Republicans released more specifics in the last week. The proposal “includes an estimated $715 billion in cuts to Medicaid and other federal health programs over 10 years,” reports MedPage Today.

Key cost-reduction strategies include work requirements for many “able-bodied” adult Medicaid enrollees as well as cost-sharing for some adults who became newly eligible for Medicaid under the Affordable Care Act. The challenge is that many struggling with addiction and lack of resources land in this group.

The House plan does propose exempting those with health challenges from work requirements. Included in this medically fragile group are those with a chronic substance use disorder.

Work requirements, however, have a dubious track record. Arkansas already tried this. It led to significant coverage losses, meaning more people became uninsured, according to a 2025 Urban Institute report. The failed experiment, halted by a 2019 federal court order, did not increase workforce participation.

A new Congressional Budget Office analysis underscores coverage loss concerns. Changes under consideration, with most savings coming from Medicaid, could result in 8.6 million Americans losing coverage.

Regina LaBelle, an addiction policy expert at Georgetown Law, sheds further light on why the “chronic substance abuse” exemption from work requirements is problematic.

“What if you are in AA or another fellowship group and are not in treatment and did not receive an official diagnosis? How do you prove your substance use disorder?”

The bottom line: There are additional barriers to treatment even with the exemption.