--- title: Obamacare Opioid Prescriptions Pain Management Surveys description: Some doctors say a quirk in the Affordable Care Act is a dangerous incentive to prescribe potentially dangerous painkillers canonical: https://time.com/4292290/how-obamacare-is-fueling-americas-opioid-epidemic/ author: Sean Gregory article:opinion: true article:content_tier: free article:published_time: 2016-04-13T16:11:58.000Z article:modified_time: 2026-08-04T07:55:53.513Z article:section: Ideas og:title: Obamacare Opioid Prescriptions Pain Management Surveys og:description: Some doctors say patient surveys have led them to prescribe more painkillers og:url: https://time.com/4292290/how-obamacare-is-fueling-americas-opioid-epidemic/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt8eb95316d560aa35/69888ef10b72e33e456e8eef/obamacare-opioid-addiction.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 5094 og:image:height: 2865 og:image:alt: New England Towns Struggle With Opioid And Heroin Epidemic og:type: article twitter:card: summary_large_image twitter:title: Obamacare Opioid Prescriptions Pain Management Surveys twitter:description: Some doctors say patient surveys have led them to prescribe more painkillers twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt8eb95316d560aa35/69888ef10b72e33e456e8eef/obamacare-opioid-addiction.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # How Obamacare Is Fueling America's Opioid Epidemic > Sponsored content. 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It explains how TIME's journalism is made, from the first pitch through the editorial decisions behind a finished story or cover. #### How can I read about how TIME chooses its covers? Inside TIME is the newsletter where TIME's Editor-in-Chief explains cover selection and the editorial reasoning behind major stories. It is free at time.com/newsletters. #### Who is the editor of TIME? Sam Jacobs is TIME's Editor-in-Chief. He writes Inside TIME, a twice-weekly newsletter about the newsroom's reporting and editorial decisions. #### Is Inside TIME free? Yes. Inside TIME is a free newsletter, available at time.com/newsletters. A paid TIME subscription is separate and available at time.com/subscribe-agent. ## Video: Supreme Court Upholds Obamacare Tax Subsidies [Watch (HLS stream): Supreme Court Upholds Obamacare Tax Subsidies](https://cdn.jwplayer.com/manifests/N52WtovW.m3u8) (0:54)  _Published 2015-06-25. Handing the Obama administration a victory, the U.S. Supreme Court voted 6-3 to uphold nationwide Affordable Care Act tax subsidies._  by [Sean Gregory](https://time.com/author/sean-gregory/)  ## Sean Gregory Senior Correspondent Apr 13, 2016 4:11 PM UTC  Oxycodone pain pills lie on display in Norwich, CT on March 23, 2016. Oxycodone pain pills lie on display in Norwich, CT on March 23, 2016. John Moore—Getty Images  by [Sean Gregory](https://time.com/author/sean-gregory/)  ## Sean Gregory Senior Correspondent Apr 13, 2016 4:11 PM UTC Not long ago Dr. Bill Sullivan, an emergency-room physician in rural Spring Valley, Ill., refused to prescribe a potentially [habit-­forming painkiller](http://time.com/3908648/why-america-cant-kick-its-painkiller-problem/) to a patient that had requested it by name. That might seem like a good thing since opioid addiction has [become a national epidemic](http://labs.time.com/story/watch-how-the-drug-overdose-epidemic-spread-in-america/?iid=sr-link7). But in fact, as a result of reforms put in place under the [Affordable Care Act,](http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html) he may have put his hospital at financial risk. As part of an Obama­care initiative meant to reward quality care, the Centers for Medicare and Medicaid Services (CMS) is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-­satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?” **Read More:** [Watch How the Drug Overdose Epidemic Spread in America](http://labs.time.com/story/watch-how-the-drug-overdose-epidemic-spread-in-america/?iid=sr-link7) To many physicians and lawmakers struggling to contain the nation’s opioid crisis, tying a patient’s feelings about pain management to a hospital’s bottom line is deeply ­misguided––if not downright dangerous. “The government is telling us we need to make sure a patient’s pain is under control,” says Dr. Nick Sawyer, a health-­policy fellow at the UC Davis department of emergency medicine. “It’s hard to make them happy without a narcotic. This policy is leading to ongoing opioid abuse.” That abuse has led to a [full-blown crisis](http://time.com/4274651/obama-opioid-addiction-summit/?iid=sr-link5). Since 1999, fatal prescription-­opioid overdoses in the U.S. have quadrupled. According to the [CDC](http://www.cdc.gov/drugoverdose/epidemic/index.html), more than 47,000 Americans died of a drug overdose in 2014, a record high, and more than 60% of those deaths involved an opioid. U.S. emergency rooms now treat more than 1,000 people every day for misusing prescription opioids. Patient-satisfaction surveys are not the cause of this crisis, of course. But there is research to support some doctors’ contention that they’re making the problem worse. A 2012 study in the _Archives of Internal Medicine_ found that the most satisfied patients are more likely to spend more on prescription drugs and have higher mortality rates. In a 2014 survey published in _Patient Preference and Adherence_, over 48% of doctors reported prescribing inappropriate narcotic pain medication because of patient-­satisfaction questions. One doctor wrote that drug seekers “are well aware of the patient satisfaction scores and how they can use these threats and complaints to obtain narcotics.” **Read More:** [Why America Can’t Kick Its Painkiller Problem](http://time.com/3908648/why-america-cant-kick-its-painkiller-problem/) CMS, which is part of the Department of Health and Human Services (HHS), disputes any link between its surveys, a hospital’s reimbursement money and opioid abuse. In March, agency doctors wrote in _JAMA_ that the patient-­satisfaction survey accounted for 30% of a hospital’s total performance score in fiscal year 2015, with pain management one of eight equally weighted dimensions, along with factors like nurse communication and cleanliness and quietness. (CMS did not respond to interview requests.) Still, lawmakers are concerned. Republican Senator Susan Collins, whose home state of Maine saw a 27.3% rise in its [drug-­overdose death rate](http://www.pressherald.com/2015/12/30/new-state-figures-show-maine-overdose-deaths-continue-to-climb/) from 2013 to 2014, has called for HHS to investigate the connection between the surveys and inappropriate prescriptions. “Health providers are telling me that these questions are written in a way that make them fear a lower reimbursement if patients did not answer them in the affirmative,” says Collins. “For a small rural hospital in Maine to lose a certain percentage of their Medicare reimbursements is a big deal.” In April, four Senators—two from each party—­sponsored a bill that would untie reimbursements from pain-­management questions. An earlier measure attracted bipartisan support in the House. Says West Virginia Representative Alex Mooney, who introduced the bill: “It’s a simple fix that can have significant results.” ## Transcript President Obama can breathe easy now. The US Supreme Court upheld a key part of the signature healthcare law. The case, King versus Burwell, involved the tax subsidies millions of Americans rely on to afford health insurance premiums under the Affordable Healthcare Act. The plaintiff's argued, based on they way one section of the law reads, these subsidies To be available only to those who enroll in exchanges quote established by the state. Now just 16 states have their own exchanges. The rest, 34 states, rely on the federal marketplace Healthcare. gov. Had the court ruled against the Obama Administration on this one, roughly 6. 4 million customers in those states would have lost their subsidies. And premiums would have almost surely increased as much as 35 % for those remaining on the Federal Exchange according to one study from the Urban Institute. But that's not going to happen. The high court agreed with the White House. 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