The debate over the fate of Obamacare has focused on the lifesaving care brought to people with cancer, diabetes, and other physical illnesses. But the law has also had a profound, effect on mental health and addiction treatment, vastly expanding access to those services.
Chad Diaz began using heroin when he was 12. Now 36 and newly covered by Medicaid under the US Affordable Care Act, he is on Suboxone, a substitute opioid that eases withdrawal symptoms and cravings, and he is slowly pulling himself together. “This is the best my life has gone in many, many years,” Diaz, a big man wearing camouflage, said.
But, reports The New York Times, if Congress and President Trump succeed in dismantling the Affordable Care Act, he will have no insurance to pay for his medication or counseling, and he fears he will slide back to heroin. “If this gets taken from me, it’s right back to Square 1,” he said. “And that’s not a good place. I’m scary when I’m using. I don’t care who I hurt.”
The report says as the debate over the fate of the health law intensifies, proponents have focused on the lifesaving care it has brought to people with cancer, diabetes and other physical illnesses. But the law has also had a profound, though perhaps less heralded, effect on mental health and addiction treatment, vastly expanding access to those services by designating them as “essential benefits” that must be covered through the ACA marketplaces and expanded Medicaid.
The report says the Centre on Budget and Policy Priorities, a left-leaning research group, calculates that 2.8m people with substance use disorders, including 220,000 with opioid disorders, have coverage under the ACA. As the opioid epidemic continues to devastate communities nationwide, public health officials say the law has begun to make a critical difference in their ability to treat and rehabilitate people.
“Of all the illnesses, this is one where we’ve seen very dramatic changes and where we stand to lose the most ground if we lose the ACA,” said Linda Rosenberg, president and CEO of the National Council for Behavioral Health, adding that treatment programmes have begun to be integrated into primary care clinics and health care systems nationwide.
The report says during the presidential campaign, Trump pledged to rid the country of Obamacare but also to address the opioid epidemic and expand access to drug treatment. Many of the states hardest hit by opioids – including Ohio, West Virginia and Kentucky – voted for Trump, but some Republican governors have expressed concern about what might happen to people being treated for addiction if their party repeals or scales back the health law.
John Kasich, the Republican governor of Ohio, where the Medicaid expansion has covered 700,000 people, has been particularly outspoken about its success in his state. “Thank God we expanded Medicaid because that Medicaid money is helping to rehab people,” Kasich said during a bill signing in January.
The report says there is still a long way to go. Waiting lists for treatment persist, and many people still lack access, particularly in the 19 states that have opted not to expand Medicaid. Nationwide, 78 people die every day from opioid overdoses, according to the surgeon general, and the number is still rising. And paradoxically, even as the number of opioid prescriptions in the US has finally started falling, expanded health coverage has probably made it easier for some people to obtain the drugs.
“There’s no doubt in my mind that improving access to health care during an era in which opioids are being over-prescribed would lead to more addiction,” said Dr Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing and an addiction specialist.
While 23m Americans suffer from a substance use disorder, the surgeon general said in a report last year that only one in 10 was receiving treatment as of 2014, the first year people got coverage through the health law. “Now what we’re doing is playing catch-up,” said Michael Botticelli, director of the White House Office of National Drug Control Policy during the last two years of the Obama administration.
The report says in the past, a third of private insurance plans sold on the individual market did not cover addiction treatment, according to federal health officials, and those that did imposed strict limits. Medicaid covered little besides inpatient detox. Now, more health care providers are offering and getting reimbursed for outpatient counseling and medications like Suboxone and Vivitrol, which have been shown to reduce the potential for relapse.
The health law encourages primary care doctors to incorporate addiction treatment into their practices. It provided grants to several hundred community health centers around the country, many in rural areas, to begin or expand mental health and medication-assisted treatment, which combines counseling and drugs like Suboxone.
The report quotes Richard Frank, a professor of health economics at Harvard Medical School as saying that this is a big improvement from the days when treatment typically was offered through scattered, poorly funded stand-alone clinics that did not necessarily provide evidence-based treatment and had long waiting lists. “The whole system is being pushed more toward looking like modern health care,” said Frank.
The 21st Century Cures Act, which Congress passed in December with strong bipartisan support, could build on the progress by providing $1bn nationwide over the next two years to expand drug treatment around the country, with an emphasis on medication-assisted treatment. The federal government will soon begin distributing the money to states, which will allot it to treatment programs, particularly in high-need areas. But if people lose their insurance, Frank said, they may well lose access to these new options.
In Kentucky about 11,000 people were receiving addiction treatment through Medicaid by mid-2016, up sharply from 1,500 people in early 2014, according to the Foundation for a Healthy Kentucky, a health policy research group. In West Virginia, Rosenberg of the National Council for Behavioural Health said, her group’s member organisations – non-profit providers of mental health and addiction treatment – are now treating 30,000 people a year, up from 9,000 before the health law.
[link url="https://www.nytimes.com/2017/02/10/health/addiction-treatment-opiods-aca-obamacare.html?emc=edit_th_20170211&nl=todaysheadlines&nlid=42505380&_r=0"]The New York Times report[/link]