Opinion writer

President Trump is and will always be a carnival barker, a snake-oil salesman, a flim-flam artist who dresses up a lot of nothing in showy garb. He’s gotten people to buy his crummy steaks, stay in gaudy hotels and pay thousands of dollars for Trump U. With that in mind, you can fully appreciate his announcement on opioids on Thursday.

The Post reported:

President Trump said Thursday that the opioid epidemic — which is killing more than 100 people each day — is the “worst drug crisis in American history” and said his administration is declaring it a public health emergency, pledging the nation’s full resolve in overcoming it. . . . With Trump’s declaration, the federal government will waive some regulations, give states more flexibility in how they use federal funds and expand the use of telemedicine treatment, according to senior administration officials who briefed reporters on Thursday morning.

But the president stopped short of declaring a more sweeping national state of emergency that would have given states access to funding from the federal Disaster Relief Fund, just as they would have had following a tornado or hurricane.

That’s it? A speech and some regulatory mumbo-jumbo? Welcome to the world of oversold, underperforming Trump bric-a-bracs. Now wonder then that “Trump’s announcement drew sharp criticism from Democratic lawmakers and some public health advocates, who questioned his commitment to the crisis, given that Trump made no immediate request to Congress for emergency funding.”

And that bait and switch — an emergency announcement accompanied by no new resources — is not the worst of it. He spent the first nine months of his presidency trying to eviscerate the most important source of funding for opioid addiction treatment — Medicaid. And the GOP budget envisions, according to the Center for Budget and Policy Priorities, “a cut of $1.8 trillion in health entitlement programs, including $473 billion in Medicare and $1.3 trillion primarily in Medicaid and subsidies to make coverage affordable through the ACA marketplaces.”

In September the Kaiser Family Foundation explained that “Medicaid covers 3 in 10 nonelderly adults with opioid addiction.” Medicaid covers screening and early intervention, overdose prevention and medication-assisted treatment. Moreover, a study in June, 2017 by MACPAC:

Medicaid is responding to the opioid crisis by covering treatment, innovating in the delivery of care, and working with other state agencies to reduce misuse of prescription opioids. However, there are gaps in the continuum of care, and states vary in the extent to which they cover needed treatment. An insufficient supply of providers also limits access to treatment in many locations. The delivery systems for physical health and behavioral health (which encompasses mental illness and substance use disorders) are traditionally separately organized and financed; the resulting fragmentation and lack of coordination can impede access to care and lead to inappropriate and insufficient use of services, poor health status, and increased costs. . . . Medicaid beneficiaries with opioid use disorder are more likely to receive treatment than privately insured adults with the disorder, both inpatient and outpatient treatment. They are about three times more likely to receive drug or alcohol treatment in a hospital as an inpatient or in a residential treatment facility than privately insured adults, and they are almost twice as likely to receive care on an outpatient basis from a mental health center than privately insured adults. Treatment services, however, remain substantially underutilized; this is often referred to as the treatment gap.

In other words, Medicaid is already struggling to keep up with the opioid abuse epidemic so further cuts with no new spending devoted to opioid treatment means more untreated people with addictions, more overdoses and more deaths.

The president has not provided direction or funds to resolve many endemic problems in treatment of opioid abuse — a shortage of treatment providers, failure to integrate mental health treatment into the larger health care system, patients’ reticence to seek treatment because of the stigma associated with addiction. As Andy Slavitt, former head of CMS (Centers for Medicare and Medicaid Services) tweeted, “This is i/2 baked at best, cynical lip service at worst.” He points out that Trump has “committed no money, named no leader and has no plan he can articulate.” Slavitt tells me, “Declaring an emergency with no funds, while putting forward this budget is on net a very bad day for people suffering from addiction.”

Trump’s way of addressing opioids — lots of show and self-congratulatory cheerleading but little substance — should surprise no one who has followed his career. Unfortunately, there are real victims here who will not benefit from Trump’s showmanship. To the contrary, they may find on net fewer resources and less access to treatment. You see, when you actually need someone to address real problems and operate the levers of government, a president with no experience, no interest in details and no willingness to prioritize tax-and-spend policies to protect the safety net is a serious impediment to action — which in this case means the death toll from opioid abuse will not decrease anytime soon.