Addiction services could be overwhelmed by health-care law

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CHICAGO — Only 1 cent of every health-care dollar in the United States goes toward addiction, and few alcoholics and drug addicts receive treatment. One huge barrier, according to many experts, has been a lack of health insurance.

But that barrier crumbles in less than a year. In a major break with the past, 4 million people with drug and alcohol problems suddenly will become eligible for insurance coverage under the new health-care overhaul.

The number of people seeking treatment could double over current levels, depending on how many states decide to expand their Medicaid programs and how many addicts choose to take advantage of the new opportunity, according to an Associated Press analysis of government data.

The analysis compared federal data on the addiction rates in the 50 states, the capacity of treatment programs and the provisions of the new health law.

Already, the prospect of more paying patients has prompted private equity firms to increase their investments in addiction treatment companies, according to a market research firm. “There is no illness currently being treated that will be more affected by the Affordable Care Act than addiction,” said Tom McLellan, CEO of the nonprofit Treatment Research Institute and President Barack Obama's former deputy drug czar. But those eager for a new chance at sobriety may be surprised by the reality behind the promise.

The system for treating substance abuse — now largely publicly funded and run by counselors with limited medical training — is small and already full to overflowing in many places. In more than two-thirds of the states, treatment clinics are already at or approaching 100 percent capacity.

In the coming years, treatment programs and medical colleges will face pressure to ramp up to create a larger system.

But until then, addiction treatment may represent an extreme example of one of the Affordable Care Act's challenges: actually delivering the care that people are supposed to receive.

Many with substance problems are waiting eagerly for January, when the new insurance will become available.

“It's the chance to clean up and not use anymore, so I could live a stable life,” said 30-year-old Ashley Lore of Portsmouth, Ohio, who was jailed and lost custody of her 4-year-old daughter as a result of her heroin addiction. “If I get into treatment, I get visitation to my daughter back. And I get her back after I complete treatment.”

Only about 10 percent of the 23 million Americans with alcohol or drug problems now receive treatment, according to the National Survey on Drug Use and Health.

Shame and stigma are part of the reason but about a quarter of them don't have insurance coverage. That compares with the overall uninsured rate of 16 percent.

The new law would provide subsidies to help many buy private coverage. The government is also pressing states to expand their Medicaid programs to include more working poor people. If 24 states expand their Medicaid programs — roughly the number now planning to do so — an additional 4 million prospective patients with addiction problems would get insurance, according to the AP analysis. If virtually all of the states eventually decide to expand, the ranks of the newly insured with addiction problems could reach 5.5 million.

Perhaps as important as the expansion, the new law designates addiction treatment as an “essential health benefit” for most commercial plans.

“This is probably the most profound change we've had in drug policy ever,” said Michael Botticelli, deputy director of the Office of National Drug Control Policy. “We know one of the most significant reasons for the treatment gap is folks who don't have insurance or who have an inadequate coverage package for substance use disorders.”

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