Healthcare Reform and the Addiction Crisis

The United States is in the middle of a severe addiction crisis which shows no signs of abating. According to the latest data provided by the Centers for Disease Control and Prevention (CDC), drug overdose deaths in the US passed another grim threshold in 2015: for the first time drug overdose fatalities surpassed the 50,000 mark.

The addiction epidemic affects all ages and ethnicities. Research by Economist Anne Case and her husband Angus Deaton revealed a big increase in what Case calls “deaths of despair,” alcohol-related liver disease, suicide, and drug overdoses.

“People kill themselves slowly with alcohol or drugs, or quickly with a gun,” Case told the PBS Newshour in February. “For people aged 50-55, for example, those rates went from 40 per 100,000 to 80 per 100,000 since the turn of the century.”

The Surgeon General reported in November that one in ten deaths among working adults were due to alcohol misuse. Describing the situation as “a serious substance misuse problem,” Dr. Murthy called for “broad implementation of effective prevention and treatment interventions and recovery supports in a wide range of settings.”

At this point, it doesn’t look like the Trump administration and the new Congress in Washington intend to implement a comprehensive strategy to combat the addiction problem. Apparently, the White House is even considering eliminating the Office of National Drug Control Policy (ONDCP) which is tasked with reducing illicit drug use.

Nearly 200 organizations representing addiction treatment, behavioral and public health experts, patient advocates, and law enforcement officials wrote to the newly confirmed director of the Office of Management and Budget in February, expressing their support for maintaining the ONDCP in view of the severity of the national drug addiction crisis.

Republicans in Congress have now presented legislation designed to replace the Affordable Care Act also known as “Obamacare.” If adopted, this bill would offer tax credits to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies currently offered by the ACA. Reactions from organizations representing public health and medical professionals were swift and mostly negative.

The American Psychiatric Association (APA) voiced deep concern that the proposed ACA replacement will negatively impact care for people with mental illness and substance use disorders.

“It is unknown how many people will lose coverage under this proposal, but discussions on implementing significant reforms to the current Affordable Care Act and Medicaid raise the possibility that a large number of people with mental illness or substance abuse disorders will lose some or all of their coverage,” the APA said in its statement.

The American Public Health Association (APHA) also strongly opposes the plan to replace the Affordable Care Act released in the House of Representatives.

"This proposal would jeopardize the health and lives of many millions of Americans,” said Georges C. Benjamin, MD, executive director of APHA. "It would dramatically reverse progress we’ve made in controlling health care costs and assuring quality care, and it would gut patient protections, investments in prevention and access to care for the most vulnerable Americans."

Among the most vulnerable Americans: many people with substance use disorders. It is feared that the repeal bill will dilute coverage requirements for addiction treatment.

As explains, the bill would keep mandatory “essential health benefits” but eliminate “what’s known as ‘actuarial value’, which essentially requires that insurers pay for a certain amount of a person’s care.“ Because many of the proposed cuts go through Medicaid and ACA tax credits, it will have a very negative impact on low-income Americans—the very people least likely to be able to afford addiction treatment.

The Republican plan furthermore allows insurers to charge a 30 percent penalty to people who let their insurance lapse and then try to buy a new policy. Again, this will mostly punish people with low or no disposable income.

So, we could soon return to a situation where insurers avoid enrolling people with mental health and substance use disorders as much as they possible can or where such patients will not even try to get insurance because they simply cannot afford to do so.

Even now only about ten percent of people who meet the diagnostic criteria for a substance use disorder receive any type of treatment and it doesn’t look like this healthcare reform will improve that ratio any time soon or effectively help combat the addiction epidemic in America.