Author: Justin Mckibben
The new Trumpcare plan, formally known as the American Health Care Act or AHCA was announced this Monday March 6th. This Trumpcare bill is the Republican Party’s long awaited plan to repeal and replace the Affordable Care Act, also known as Obamacare.
Since day one of the announcement we have seen quite a few varying opinions as to what this means for the people who were previously covered, and what it means for how healthcare altogether might change. Needless to say, not that much of the talk has been optimistic. As details emerge about Trumpcare some have become increasingly worried about the impact it will have on access to treatment for substance use disorder, especially for low-income Americans.
So what some are officials and experts saying about Trumpcare, and what it might mean for Americans struggling with addiction?
Early Predictions on Trumpcare
According to some early reports, 6-10 million Americans will lose health insurance. Not only that, millions of people in desperate need of help could be cut off from access to addiction treatment as a result of the bill.
In fact, according to one analysis, approximately 2.8 million people living with substance use disorder will lose some or all of their health insurance coverage if Obamacare is repealed. This conclusion comes from:
- Harvard health economist Richard Frank
- Sherry Glied, Dean of the Wagner School of Public Service at NYU
The publication The Hill reported in January that Frank and Glied predict that the federal government’s 21st Century Cures Act creates a recent investment of $1 billion to tackle opioid abuse. However, they state this provision would be- “squandered if the new Congress rolls back recent gains in the quality and level of substance use and mental health insurance coverage generated by the Affordable Care Act (ACA) of 2010.”
Surely this is all “fake news” and “alternative facts” right?
Not so much. According to reports from the Washington Post Thursday, House Republicans admitted, after questioning by Massachusetts Democratic Representative Joe Kennedy III, that their the Trumpcare plan to repeal-and-replace would- “remove a requirement to offer substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans.”
How does this happen? By attacking the expansion of Medicaid and the ‘essential benefits’ states are required to provide for.
Trumpcare Impact on Medicaid
Trumpcare’s plan to roll back Medicaid and health insurance tax credits are pretty distressing aspect of this reform. For all the Americans who rely on government assistance for addiction treatment this is a pretty huge deal.
Addiction treatment in the past is notably impacted by Medicaid. According to Truven Health Analytics, Medicaid was the second largest payer for addiction treatment, after state and local programs, in 2014.
Starting in 2020, Trumpcare is set to:
- Freeze Medicaid enrollment
- No longer require Medicaid to cover essential health benefits like addiction treatment
What is the point? To make it so the federal government pays less for Medicaid over time by shrinking coverage.
So if this is all the case, it is a terrifying reality. In a time when more Americans than ever desperately need addiction treatment, in the midst of an opioid epidemic that is tearing families and communities apart, the government’s Trumpcare plan stands to save money by stripping addiction resources from those relying on Medicaid?
Representative Kelly and Peter Welch, Democratic Representative from Vermont, attempted to amend the bill to restore the federal mandate for those ‘essential benefits’ but were voted down. Kenny is popularly quoted in the news recently for his statement,
“There is no mercy in a country that turns their back on those most in need of protection: the elderly, the poor, the sick, and the suffering. There is no mercy in a cold shoulder to the mentally ill… This is not an act of mercy — it is an act of malice.”
While Trump’s comments say he wants to give states “flexibility” with Medicaid to make sure no one is left out, many believe this is just adding the idea of paying more for less.
Senate Minority Leader Chuck Schumer vows to lead efforts to defeat Trumpcare, stating he believes it will “Make America Sick Again” and believes that it will create more drug addicts. In a report from The Hill Schumer attacks the bill saying,
“To make matters worse, this sham of a replacement would rip treatment away from hundreds of thousands of Americans dealing with opioid addiction, breaking the President’s word that he would expand treatment, not cut it.”
This is continuously troubling. When it comes to the fight against addiction, President Trump’s administration seems to be more focused on borders and “law and order” than providing resources. Trump did promise to work on creating more coverage options, but all the action taking place almost points the opposite direction.
Trumpcare Impact on Treatment Providers
This chain reaction wouldn’t just hurt those who need insurance by denying them coverage. Experts say Trumpcare also has the capacity to do damage to the treatment providers themselves.
Keith Humphreys, a drug policy expert at Stanford University, points out this issue directly. Humphreys notes that treatment providers, which tend to be small businesses in many parts of the country, may find it difficult to stay in business if clients lose coverage for addiction treatment. If less people are able to get coverage, less people will be able to get treatment. At the same time even bigger treatment providers could have trouble because it still has the capacity to reduce reimbursement rates for treatment services.
Thus, Trumpcare could affect both the supply and quality of treatment. In one interview Humphreys states,
“Most providers are small, mono-business entities that can’t absorb costs elsewhere in their care systems,”
“While hospitals will not go broke if poor people get less oncology care coverage, many [substance use disorder] treatment agencies will.”
But it isn’t just Democrats or University Professors or addiction experts speaking out. The AARP, the American Hospital Association, and the American Medical Association voice opinions against the overhaul of the ACA and the potential harm Trumpcare could do.
Even Republicans are speaking out against the danger that Trumpcare poses to addiction. Ohio Governor John Kasich is vocal with his own opposition to the bill saying,
“[Trumpcare] unnecessarily puts at risk our ability to treat the drug-addicted mentally ill and working poor who now have access to a stable source of care.”
Not to say that healthcare was ever perfect. It is noted by many doctors in the addiction field, as well as politicians and other experts, that there is already a treatment deficit. Approximately 10% of America’s population has what could be considered a substance use disorder, and only 13% of those people ever get treatment.
However, the miles of red tape Trumpcare might wrap around them could cut that number drastically. So even if these are unintended consequences, they are very real consequences just the same.
Obamacare was far, far from perfect. This is absolutely true. But is Trumpcare the best answer we can come up with?
As it now stands, Trumpcare may take so much away from those struggling with addiction and mental health that some experts are calling it dangerous. Having safe, effective and comprehensive treatment resources for these issues is extremely important to the preservation of life and the future of America. This is a matter of life and death. It is not the time for an ‘anything but Obamacare’ mentality… if the government expects a better plan, they need to make it happen. How about we put a hold on spending billions on border walls and expanding the nuclear program, and instead focus on healing Americans who need it most.
If you or someone you love is struggling with substance abuse or addiction, think about who you want to be working with to find a real solution. Please call toll-free now.
CALL NOW 1-800-951-6135
Author: Shernide Delva
President Barack Obama will make a budget request to Congress for $1 billion dollars to fight drug abuse and overdoses. The amount of overdoses in the United States is currently at an all-time high. More than 47,000 people died from drug overdoses last year, according to the CDC. That exceeds the amount of deaths in traffic accidents. Obama’s budget request aims to expand treatment specifically to those suffering from abusing prescription opioid painkillers as well those using cheaper drugs like heroin.
The majority of the $1 billion dollars would go to states under joint state-federal agreements increase the amount of people who have access to treatment. A smaller portion of $50 million would pay for a corps of 700 providers who know how to use drugs and therapy to treat drug addiction.
“Second, the President’s budget includes approximately $500 million — an increase of more than $90 million — to continue and build on current efforts across the Departments of Justice and Health and Human Services to expand state-level prescription drug overdose prevention strategies, increase the availability of medication-assisted treatment programs, improve access to the overdose-reversal drug naloxone, and support targeted enforcement activities,” the White House said in a statement.
The drug naloxone, more commonly known by its trade name Narcan, can quickly reverse the effects of an overdose. Many states and cities are ensuring that first responders have naloxone on hand to save the lives of those who have overdosed. Recently, a variety of efforts has been made to make Narcan more readily available. Everything from having school nurses has access to the drug to making the drug available over the counter at pharmacies. With Narcan, the quicker a patient receives the drug, the better chance they have of surviving.
In the past, Obama has made it clear in the past that the opioid overdose epidemic is a priority for his Administration. Not long ago, the president issued a memorandum that served to combat the opioid epidemic through improving education and training as well as increase access to treatment. In 2012, health care providers wrote 259 million prescriptions for opioid pain medications– enough for every American adult to have a bottle of pills.
Obama went to West Virginia in October to hear personal accounts from individuals and families affected by the epidemic. West Virginia has the highest rate of overdoses in the country. He spoke to health care professionals, law enforcement officers, and community leaders working to prevent addiction and respond to its aftermath.
The President’s FY 2017 budget takes a two-pronged approach:
First, it includes $1 billion in new mandatory funding over two years to expand access to treatment for prescription drug abuse and heroin use. The funds are allotted in the following ways:
- $920 million to support and expand access to medication-assisted treatment for opioid use disorders. States can use these funds to expand treatment capacity and make services more affordable.
- $50 million in National Health Service Corps funding to expand access to substance use treatment providers. This funding will make it possible for close to 700 providers to provide substance use disorder treatment services in areas across the country most in need of behavioral health providers.
- $30 million to identify and evaluate the effectiveness of various treatment programs. This money would be used to understand the real-world conditions of drug abuse and understand the unique needs of patients with opioid use disorders.
Second, the president will increase the budget by close to 90 million for the Department of Justice (DOJ) and Health and Human Services (HHS). The increase in funds will be used to continue to implement prevention strategies as well as increase the availability of medication-assisted treatment programs. The budget includes an HHS pilot program for nurse practitioners and physician assistants to prescribe buprenorphine for opioid use disorder treatment, where allowed by state law. Another objective is to increase access to Naloxone (Narcan) with these funds. The budget includes an HHS pilot program for nurse practitioners and physician assistants to prescribe buprenorphine for opioid use disorder treatment, where allowed by state law.
Along with President Obama’s announcement come several proposals from presidential candidates for the upcoming election. It is clear that the drug epidemic is going to be a critical topic to tackle in the next coming years. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Shernide Delva
Last month, Health and Human Services Secretary Sylvia M. Burwell announced an initiative to provide $685 million in awards to 39 national and regional healthcare networks and supporting organizations. Have you ever been in a hospital where you felt more like a number than a patient? This initiative wants to address those issues that are affecting our hospitals and health care facilities nationwide. The initiative called the Transforming Clinical Practice works as a part of the Affordable Care Act.
The goal is to equip more than 140,000 clinicians with tools and support needed to mainly:
- Improve Quality of Care
- Increase Patients’ Access to Information
- Reduce Costs
The $685 million will be one of the largest federal investments given to support clinicians and will impact all 50 states through collaborative and peer-based learning networks. Secretary Burwell, elaborated by saying:
“These awards will give patients more of the information they need to make informed decisions about their care and give clinicians access to information and support to improve care coordination and quality outcomes.”
Overall, the goal is to move toward a wellness-based approach to managing care. For example, The American Board of Family Medicine will work with more than 25,000 family physicians serving 50 million or more patients to help clinicians and patients navigate the changing healthcare system and reduce disparities in healthcare.
The efforts of the initiative will accomplish the following and more:
- Help providers give patients better tools for communication
- Provide dedicated coaches to better manage chronic disease and offer preventive care
- Offer real-time notification alerts for clinicians caring for high-risk patients
- Improve screening and treatment of mental health and substance abuse across multiple care settings
- Centralize data reporting with technical assistance
- Promote patient, provider and community engagement
In the past, patients felt like nothing more than a number. The care in hospitals was becoming less personal and more data-based. As a result, this initiative hopes to accomplish fostering new levels of coordination, continuity and integration of care. The ultimate goal is to transition from volume-driven system to value-based, patient centered healthcare services.
Secretary Burwell released the awards in conjunction with a round-table discussion with Members of Congress and health care leaders. They discussed ways to transform our nation’s health care system into a system that rewards value over volume.
During the conference, it was announced that part of the funds would support 29 medical group practices, regional health care systems, and regional extension centers in offering peer-to-peer support to primary and specialty physicians, nurse practitioners, physician assistants, clinical pharmacists, and their practices.
In addition, $27 million would be given to 10 national organizations and health care professional associations in order to:
- Align clinical practice guidelines across multiple medical specialties so there is uniformity.
- Offer Continuing Medical Education credit to clinicians to support transformation efforts
- Share best practices and provide technical assistance and coaching to their members; discuss alternative payment methods.
- Provide educational materials and access to registry data information and training on how to use the data to improve care.
These awards come as part of a comprehensive strategy advanced by the Affordable Care Act to build upon successful models and programs such as the Hospital Value-Based Purchasing Organization Program, Partnership for Patients with Hospital Engagement Networks, and Accountable Care Organizations.
Americans need a health care system that delivers the right care, at the right time, and at a cost that is reasonable and easy to understand. Now patients will be able to reply on their doctors and health care team to provide them the quality of care they need. Such a system will result in fewer unnecessary hospital admissions and readmission, fewer healthcare-associated infections, and reduced patient harm, and will show continuous improvement in quality outcomes and cost efficiency.
The more efficient our health care system the better chance more people will be taken care of properly. As more and more people suffer from addiction, improving access to medical facilities becomes a more important issue. If you or someone you love is struggling with substance abuse or addiction, please call toll free 1-561-221-1125.
By Cheryl Steinberg
The Affordable Care Act (ACA), also referred to as Obamacare, has been hailed a veritable god-send for those struggling with substance abuse and addiction as it makes access to treatment such as rehab a lot more widespread, meaning that many people who would otherwise not be able to get help, now can.
Sounds great, right?
Well, the hitch is this: Obamacare will only pay for what is considered to be “evidence-based treatment.” However, as a result, rehabs are now eliminating 12-step fellowship programs in favor of programs like harm reduction and other approaches that can be statistically measured and that show strong numbers.
At first glance, the Mental Health Parity and Addiction Equity Act seems to be an extremely promising thing for both those working in the rehabilitation industry and of course, those seeking treatment. It also seems like a good thing for the more intensive care model, as a return to the glory days of the 1980s when it was more the norm to be able to attend a 30-day inpatient drug rehabilitation program.
How Obamacare and AA are at Odds
The Mental Health Parity and Addiction Equity Act is a section of the Affordable Care Act of 2008, which requires that insurance companies cover the costs for mental and addiction treatment just as they would for general medical treatment, such as for physical ailments. In a nutshell, the Mental Health Parity and Addiction Equity Act ensures that insurance will pay for a 30-day inpatient program for those who require it.
Historically, Alcoholics Anonymous has depended quite heavily on drug treatment facilities to introduce their patients to 12 Step fellowships and, in fact nearly 100% of drug rehabilitation programs treat their patients with approaches that rely heavily upon the Alcoholics Anonymous abstinence-based model. About 98.6% of all rehabs in the United States are at least in part 12-step oriented with 78.8% directly using the 12-Step Facilitation Model.
The Mental Health Parity Act and Its Fallout
Originally, the Mental Health Parity Act gave medical practitioners within the field of drug and alcohol rehabilitation new hope that access to their treatment facilities would increase as a result of the new law.
The issue lies with a part of the law called the Final Rule, which went unnoticed by most of the industry when they made their initial projections. The Final Rule states that all insurance covered treatment must be evidence-based medicine. What this means is this: the treatment methods used in facilities applied must be able to be proven effective and the level of treatment must be in accordance to what is deemed necessary by scientific studies. So, unfortunately for 12-step methods, it means that insurance can – and will – flat out refuse to pay for inpatient 12-step facilitation simply because it is not proven to be effective.
Two industry giants: Hazelden and Betty Ford recently had to merge into one program, indicative of just how much trouble the treatment industry is currently in. Betty Ford had to merge with Hazelden in order to survive under the new healthcare law and even changed up its treatment approach, focusing primarily on outpatient care. Bottom line: the statistics show that, as the rehab industry goes so does AA.
So, just how bad is it? A major insurance company, Cigna has refused 47% more inpatient treatment claims than general inpatient treatment claims due to “a lack of evidence-based treatment.” Another major healthcare carrier, United Healthcare, has also significantly increasingly denied addiction treatment under the new law.
As a result, both insurance companies were involved in class action lawsuits. Cigna ended up settling. The law continues to be tested in court and the debate will continue simply because inpatient treatment using the Alcoholics Anonymous approach is simply not proven to be effective. While this is an obvious blow for proponents of AA, it is encouraging to those who stand behind evidence-based medicine. The American Mental Health Counselors Association considers the Final Rule as a major step forward for addiction treatment.
There are many different approaches in the treatment of alcohol and drug addiction and studies show that a multi-modality approach is the best. Everyone recovers differently. At Palm Partners, we recognize that our clients deserve access to all the different therapies and treatments available for people with substance abuse and addictions. We take a holistic approach that nourishes the mind, body, and spirit. Call toll-free 1-800-951-6135 to speak directly with an Addiction Specialist. You are not alone.
You’ve finally accepted the fact that you’re dealing with a problem that’s bigger than you and you’re ready to get help. This is typically how it goes for people like us, people who struggle with substance abuse and addiction. Or, perhaps you’ve gone to treatment in the past, maybe even put together a little (or a lot) sober/clean time but, you experienced a relapse and are ready to get back on the wagon. There’s one question remaining, “How do I pay for it?”
So, you’re thinking, “I need rehab but I can’t afford it, now what?”
Here are three main scenarios you might find yourself in as well as options on how to go about paying for rehab.
1: You have insurance but the co-pay or deductible is too high
First off, you might be one of the many people who has private insurance but isn’t aware that substance abuse and addiction treatment is covered by your plan. If you have a private plan – through your place of employment, a family member or self-pay, most likely your plan covers substance abuse treatment.
That’s because substance abuse and addiction are recognized as chronic illnesses that require specialized treatment. Therefore, most health insurance plans include coverage for such treatment.
Now, if you already knew this (or if you’re just finding out), the next hurdle is the co-pay/deductible. Unfortunately at times, even though a private plan may cover substance abuse treatment, there can be a high deductible or an expensive co-pay. If this is the case, don’t fret! Often times, rehabs will be able to work with you. They may be able to set up a manageable payment plan, refer you to a center that is better covered by your insurance plan, or they may even have partial scholarships available for those that qualify. Also, check suggestion number four for other ways to come up with the copay or deductible.
2: You don’t have private insurance
Luckily, The Affordable Care Act has been passed and is already up and running. You may be more familiar with the term ‘Obamacare,’ a national insurance program that’s been established to ensure that every American has access to medical treatments and interventions. Even better news is, addiction and substance abuse treatment, such as attending rehab is covered by Obamacare.
Go to the main website for the Obamacare marketplace
and do a search by state and click on “research options” in order to find out where you can go to rehab with your plan. All options are required to have some sort of addiction coverage. Make sure to check out deductibles and co-pays. If your plan comes with one of these and you can’t afford it, see #1.
If you have not yet enrolled then, you must wait for the next open enrollment which takes place in November. If you cannot wait until then, there is a chance that you qualify for special enrollment.
3: You don’t have Obamacare yet and you don’t qualify for special circumstances to enroll late
If you can’t wait until November and you have Medicare or Medicaid, contact them to see what options you have for treatment. If you are ineligible for these programs, it’s still possible to go to treatment. There are state-run rehabs that do not require insurance and either free or offered on a sliding scale based on your income. Refer to the SAMHSA website to find out about facilities near you.
Often times, there is a wait to get into one of these treatment facilities. If that’s the case, there are a few other things you can try…
4: The Wild Card
There are a few out-of-the-box options to try when you need rehab and can’t afford it. You can:
Put it on your credit card
Apply for a loan
Get a government grant
Sell valuable possessions – hey, it’s worth it to save your life!
Also, keep in mind that although treatment is often the best approach, there are many of people who have gotten sober and/or clean ‘in the rooms.’ Go online to find a local 12 Step meeting.
If you or someone you love is struggling with substance abuse or addiction and you need help finding out how you can pay for rehab, call an admission specialist today at toll-free 1-800-951-6135.