Commentary
One of the most important—and difficult—roles of government is to craft a budget rooted in reality, in which spending is aligned with revenue. When I took office as governor of New Jersey, the state faced an $11 billion deficit on a $29 billion dollar budget. I’ll be the first to admit that the process of closing that enormous gap was slow, grueling work, and it rarely left anyone happy. Even so, it was also an opportunity to embrace new ideas, strengthen existing policies, and eliminate inefficient spending. The end result? A balanced budget that was smaller than the year before.
As tough as the budget situation was in New Jersey when I took office, our federal budget is in even more desperate need of an overhaul. Considering that the national debt currently stands at a staggering $36.2 trillion—with interest on the debt now exceeding the defense budget—coupled with the recognition that there has been an annual federal deficit for the last quarter century, it should be clear that significant and well thought out program reforms and spending cuts are essential to turn things around. Congress has begun this important work with the budget resolution and will now spend the coming months on budget reconciliation legislation reducing spending to meet real world fiscal targets.
Yet even as every program is reviewed and necessary cuts enacted, it is vital that our most important priorities be maintained—one of which is continuing the progress being made combating the opioid epidemic.
The opioid crisis continues to be a plague on American health, well-being, and prosperity. More than 645,000 lives have been lost, a number made even more painful to bear considering that each of those lives touched countless others among us—family members, friends, and colleagues. States, communities, schools, and families across the country have grappled with the devastating consequences of substance abuse and have called upon our nation’s leaders to lead the charge against this silent killer. Leaders in both parties have answered the call at both the state and federal levels through bipartisan support to raise awareness, improve prevention, and expand access to treatment. One of the most effective ways of providing access to treatment is the Medicaid program, which provides coverage for medication-assisted treatment (MAT) and other forms of care for opioid and substance use disorders (OUDs/SUDs).
In my work both as governor and chair of the
President’s Commission on Combating the Opioid Crisis, it quickly became clear that addiction is a disease. It also became clear that fighting the opioid epidemic would demand a unified, strategic, and comprehensive approach, with federal, state, and local governments collaborating alongside community organizations, families, and health care providers. That’s why the commission made
over 50 recommendations that touch upon every aspect of addressing the opioid crisis. Since then, the federal government—including both Congress and the executive branch—has implemented many of the commission’s recommendations, including actions by the Centers for Medicare and Medicaid Services (CMS) for much-needed expansion of Medicaid coverage for OUD/SUD treatment.
State Medicaid programs cover
nearly 40 percent of people with OUD and provide access to the most effective treatments. MAT programs are proven to be highly effective in preventing relapse, increasing retention in treatment, and reducing the risk of overdose death by up to 75 percent. The commission’s report stressed that MAT programs were critically underfunded and underutilized. In response, CMS required MAT coverage in all Medicaid programs. As a result,
63 percent of Medicaid enrollees with diagnosed OUD now access MAT programs.
Medicaid funding also supports innovative efforts by state governments as they develop new approaches in how we treat OUD and support formerly incarcerated individuals reentering society. As of January 2025,
more than half of all states have developed or are in the process of creating Medicaid Reentry Section 1115 Demonstration Projects. These projects allow states to access Medicaid reimbursement for OUD health care services up to 90 days before release. Creating access to pre-release services to treat OUD undoubtedly saves lives and provides previously incarcerated individuals with the tools to succeed as they forge a new path in society.
Efforts to combat the opioid crisis have clearly borne fruit in reduced mortality, improved health, and recovered lives. For the first time in decades, data shows that nationwide
overdose deaths are on the decline, with some states seeing drops of up to 30 percent. Thousands of lives are being saved by the policies that our country has implemented. The best way that Congress and the president can take the measure of this success is to recommit our government to building on the progress we have made.
I understand that tackling gaping budget deficits is a herculean task, and that painful cuts must inevitably be made. However, continuing to provide access to OUD/SUD treatment is a priority that touches communities and families across America. Approximately
two-thirds of Americans know someone who is struggling or has struggled with SUD. According to
recent data published by the Kaiser Family Foundation, about 65 percent of Medicaid enrollees under the age of 26 use the program for some type of SUD treatment or service, and 78 percent of enrollees age 27 to 44. Medicaid provides coverage for a range of OUD/SUD treatment across care settings in every state. Interrupting the progress that has been made in recent years will surely cause irreparable harm to our neighbors, coworkers, and friends struggling with SUD, as well as their families and our communities at large.
Now is not the time to risk progress by unwinding reforms that have been so effective. Now is the time for Congress to safeguard access to OUD/SUD treatment in the budget reconciliation process. OUD/SUD recovery cannot occur without adequate treatment, adequate treatment cannot take place without Medicaid, and Medicaid requires the continued support of the federal government.
Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.
