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HOT TOPICS: Alcoholism  Addiction  AA  Cocaine  Heroin

The Effect of ObamaCare on Treatment

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Does it care for addicts? Shutterstock

By Marissa Rosado

04/21/14

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The bad news

The first on this list is a small strike, but worth mentioning. When applying for health insurance, candidates are asked about their tobacco use. It’s a simple question: “Do you use tobacco products?” If the answer yes, the ACA has allowed insurance companies to charge that applicant a higher premium. Another reason to quit smoking, sure, but that also seems oddly close to discrimination, especially considering the ACA’s seemingly open arms policy when it comes to a history of drug use.

The Affordable Care Act has mandated that all health insurance plans sold on American Health Insurance Exchanges must provide means for treating substance abuse. 

With some exceptions.

Small employer (businesses of 100 employees or less) plans put in place before March 23, 2010 don’t have to provide these benefits. Church-sponsored plans are also exempt. Even Medicare and Medicaid are excused from this mandate. These exemptions could leave many without the help they need.

And what about the demand for substance abuse treatment? Now that millions previously suffering from addiction are eligible for health insurance, they’re all going to need professionals to treat them. Just one problem: currently there aren’t enough professionals properly trained to treat recovering addicts. There is a gap between the number of prospective patients and the number of professionals ready to treat them. Many addicts need intervention and other preventative measures, which require specific training and certification. It’s disappointing that this is the case, because if one checked in on the process of implementing the ACA, there are months of news stories pointing to the roll out encountering some difficulty (to say the least). The system crashed multiple times due to the volume of applicants. How was this not noted and taken into consideration with regard to specialty treatment? This gap is going to provide a longer wait time for those in need, time that in some cases will mean the difference between life and death.

The worse news

When visiting the website for the ACA on whitehouse.gov, eventually it leads to pages underneath the Office of National Drug Control Policy.  On the subject of treatment, this is what the office has to say:

Treatment of substance use disorder consists of a range of clinical interventions that can include group and individual therapy, medication for detoxification, and stabilization. The ultimate goal of treatment is to assist individuals in achieving stable, long-term recovery, enabling them to become productive, contributing members of society and eliminating the substantial public health, public safety, and economic consequences associated with active addiction.

That’s odd. Did you read anything in there about covering rehab programs? There’s no mention of them. Does that mean rehab is a “Specialty Treatment," suggested by another link on the page? No. The specialty treatments mentioned are medicines approved to treat substance abuse in conjunction with behavioral therapy. 

The lack of literature on the availability of rehab coverage is concerning. For many, rehab is necessary to combat their addiction. The website also doesn’t mention whether or not the cost of care is adjusted if this is a patient’s second, third, fourth trip back to rehab. Relapsing is a hard reality of substance addiction; the possibility of it must be addressed under the ACA.

In regard to how the ACA will be supported, there is a two-pronged plan. One is High Intensity Drug Trafficking Areas (HIDTA), which pushes for all levels of government to coordinate efforts to bring down drug trafficking. Another suggests reform within the criminal justice system to break the cycle of drug use causing crime leading to further drug use.

What’s missing from this enforcement is the promise of care, not to mention the quality of that care.

The sad truth is that the ACA is primarily focused on substance abuse prevention. It falls seriously short in specifying how it will treat those active drug users seeking recovery.

Mistakes made before

The risk of sacrificing quality of treatment in order to treat the quantity of patients harkens back to the implementation of methadone clinics in the UK during the 20th century. In that situation, government-sanctioned substance abuse clinics were opened and offered medication and counseling to individuals addicted to heroin. In theory, the methadone provided a crutch to help the addict wean off, and counseling was there to support the process. The result of this plan was disappointing: the number of drug users in the UK jumped from 67,000 in the 1990s to 200,000 in the late 2000s. 

The biggest problem this government-implemented abuse treatment facility is facing is quality of care. One researcher of the institution, David Best, noted a patient going in and out of clinics for a year, receiving regular amounts of methadone, and little to no counseling. This sounds an awful lot like enabling. Sacrificing quality of care is a sure risk with the ACA. Additionally, how did no one within the system get on to the fact that this patient was taking a weaning-off dose for nearly a year? The answer is simple and unacceptable: the patient was not being tracked. There was no system in place to track patients from clinic to clinic, so one only wonders how many others were taking these same liberties. If the ACA fails to appropriately monitor those seeking substance abuse treatment, those in need may receive no help at all.

The mistakes made with the UK's methadone clinics echo the larger problems in the ACA. Loopholes left unchecked will be exploited and disrupt the quality of care. If the ACA doesn’t tie up the loose threads concerning rehab, relapse, and quality of care, those in recovery are still vulnerable.

Marissa Rosado is a regular contributor to The Fix. She last wrote about red flags for kids with potential addictions.

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