Author: Justin Mckibben
When we talk about national addiction recovery, what we mean is acknowledging how we as a country and a culture are recovering in our communities. How are we supporting those in addiction treatment? What services are we making available? How is our economy recovering? What are we doing to prevent the spread of addiction?
So if we are taking away resources that not only treat those already struggling, but also prevent more people from suffering, how do we expect to ever escape the devastation caused by the opioid epidemic and rise of overdose deaths?
One of the most divisive issues facing America today is access to healthcare and the extent to which health coverage should or should not be provided. The debate has gone on for a long time, and in the shuffle of each proposal, it seems mental health and addiction services are constantly threatened. Recently there have been more attacks on addiction treatment access. So how is the possibility of more decreases in health coverage going to hurt national addiction recovery?
The Parity Protections
Once upon a time in 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) created guidelines that required health insurers to treat mental health and addiction coverage exactly the same as they would with medical and surgical care options. So this means that prior to the MHPAEA those who were lucky enough to have health insurance still could not be guaranteed to receive equitable benefits for mental health or substance abuse care.
These protections were even further expanded by the Affordable Care Act (ACA) and legislation put forth by Congress in 2016 with the 21st Century Cures Act, which includes tougher enforcement of parity requirements.
Since the Trump administration stepped in adamantly proclaiming the goal or repealing and replacing the ACA there has been a lot of concern about whether or not any new proposals will decrease health coverage for mental health and addiction services. Many addiction and mental health advocates worry that parity protections and enforcement will also lose their power.
As of yet, politicians are still hoping for a compromise that will keep the protections and resources for treating addiction and mental health intact.
BCBS Cuts Mental Health Coverage
One instance of concerning changes in policy has come out of Minnesota. Just this September the largest insurance carrier in the area, Blue Cross Blue Shield, is making drastic decreases to payments to mental health providers.
We are talking about cuts in addiction and mental health coverage to the tune of that’s 33%!
This decision came after a recent survey showed that the individual therapy costs of Minnesota had exceeded the national average for the last two years. But mental health professionals immediately spoke out against this move. Protests actually took place on Thursday the 14th outside the headquarters of Blue Cross Blue Shield in Eagan, MN. Many advocates and protesters are saying these kinds of cuts will put mental health clinics out of business.
The insurance provider is now under fire as caregivers insist this change will discourage necessary, extended psychotherapy services. People in Minnesota see decisions like that of BCBS as being a violation of the protections offered by parity.
If this kind of policy shift within insurance providers becomes a trend, we could see a dramatic decrease in the people getting substance abuse and mental health treatment. These changes can hurt our national addiction recovery by slowly cutting off the people who need every chance they can get, especially during a devastating opioid epidemic.
Threats within Medicaid
Believe it or not, Medicaid is currently the single largest payer for behavioral health services in America. Threats to the Medicaid health coverage of services like this could do critical damage.
At one point the Trump administration and congressional leaders seemed partial to the idea of turning Medicaid into a block grant program. This strategy would give states a fixed amount of money to provide healthcare for low-income residents. However, policy experts say that means states would have to:
- Reduce eligibility
- Narrow the scope of benefits
- Impose cost-sharing requirements
All of which would also impact the number of people seeking substance abuse and mental health treatment.
Recently GOP representatives and the Trump administration began the work of fundamentally altering state Medicaid programs. Some of these new requirements include governors pushing for:
So again, there is the very real possibility of more hurdles being put in-between those who need help and the already limited resources available to them.
Stigma Influencing Policy
The bigger part of this issue is that these shifts are happening in a way that shows how stigma is influencing policy. We are only further hurting our national addiction recovery by letting this idea that addiction is a moral failing or class issue limit what we are willing to provide to those who need help.
The reason behavioral and mental health services are so crucial is because the cause of addiction is not just the drugs themselves. The vast majority of recovery advocates endorse the concept that addiction develops from multiple factors, such as:
- Lack of access to resources
- Poor social networks
So in fact, by limiting coverage to mental health services, the problem could be magnified.
Mental health services like behavioral therapy being lost with a decrease in coverage means that more children and young adults could go without the support systems. What this does is puts more people in the exact circumstances where we see substance abuse and addiction grow.
So in essence, not only could these constant threats to addiction and mental health coverage be taking away treatment for those already addicted, but it also takes away from prevention programs in communities that fight to keep addiction rates down.
National Addiction Recovery Effects Everyone
If we have any hope of having sustainable national addiction recovery then it is vital that our country continues to push for mental health parity in every discussion about healthcare. If we ever hope to overcome the demoralization of communities we have to fight for mental health and addiction services.
This isn’t about treating the individual’s symptoms with just medications either. Access to other crucial elements like housing, medical care, and basic preventative measures all contribute to the overall mental health of any individual.
When people have better access to the specific levels of care they need, we empower them to contribute to the better communities we need for healthy nation-wide recovery.
People struggling with substance abuse and mental health disorders deserve comprehensive and compassionate treatment, and we should all fight to protect coverage that makes treatment more available. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-800-951-6135
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Justin Mckibben
Addiction is not an easy problem to address. It is a complex issue with many variables, so of course there is no simple answer to fix it. There is no one-size-fits-all solution; no monopoly on the right kind of treatment. It is understandable that there is a degree of effectiveness with utilizing any medical means available to try and address addiction, but are maintenance drugs really the answer?
Surely medication assisted treatment is useful, and it helps a lot of people. Most inpatient treatment programs utilize some form of medication to ease withdrawal symptoms and other side-effects of long-term drug use. The detox period of treatment usually focuses on medically assisting someone struggling with drugs in this transition.
However, is getting people off of one drug by making them dependent on another really the best case scenario? It seems now insurance companies are putting more effort into using maintenance drugs to treat addiction. Is this really a better strategy?
Firstly, let us make a clear definition of what maintenance drugs are. Typically, the definition of maintenance drugs is along the lines of prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines.
Examples of common maintenance drugs are medications such as:
- Fluticasone and salmeterol (Advair Diskus) which is used to treat asthma
- Insulin glargine (Lantus) used to treat diabetes
If you consider these examples the point is that people use these medications to “manage” their illness, not to overcome or remedy it. So looking at the issue of addiction, there are some well-known maintenance drugs, specifically concerning opioid addiction.
These medications can be effective, but they also present a level of danger themselves. Even though doctors prescribe them to combat withdrawals, they actually can create their own devastating withdrawals, especially with long term use.
Aetna Aims for Maintenance Drugs
Aetna is one of the nation’s largest insurance companies. In a recent Aetna report, the company is prepared to remove a major restriction for patients seeking maintenance drugs for opioid addiction. The change is set to begin this coming March. Aetna is the third major health insurer to announce such a shift in policy in recent months, now in league with Anthem and Cigna insurers.
To be more specific, this insurance company will stop requiring doctors to seek approval before they prescribe particular medications that are used to combat withdrawal symptoms. One of these medications is suboxone, a well-known medication that many people use to fight opiate addiction.
The common insurance practice is known as “prior authorization”. The reason they are seeking to eliminate this policy is because it sometimes results in delays of hours to days before a patient can get the medications.
This new approach to regulation of maintenance drugs impacts all its private insurance plans, an Aetna spokeswoman confirmed.
Advocates of Maintenance Drugs
Addiction treatment advocates to support having expanded access to maintenance drugs. Dr. Corey Waller, an emergency physician who chairs the American Society of Addiction Medicine’s legislative advocacy committee, states:
“It’s a first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. [For] every other disease with a known mortality, the first-line drugs are available right away.”
Essentially, the idea that parity laws require insurers to cover addiction treatments at the same level as other kinds of healthcare means these kinds of medication should be available for immediate access. This should be the same for all forms of addiction treatment.
Opinion: Treatment over Maintenance
While many would argue that maintenance drugs are a form of treatment, it is still a relevant argument that maintenance drugs are also imperfect and could actually be harmful if they become the cookie-cutter answer implemented by most insurers.
While harm reduction is understandable, and maintenance drugs can help people struggling with heroin or other dangerous opioids avoid other serious risks, the fact is many maintenance drugs include their own side-effects. Some often become subject to abuse themselves.
For instance, suboxone can be useful as a harm reduction tactic, but it can also be abused. Many people who have used suboxone as a long-term solution have found themselves battling suboxone withdrawal symptoms. The dangers of suboxone are very relevant.
The same, if not worse, has often been said about methadone maintenance drugs. While they may keep someone alive to get treatment, there should still be a strong emphasis on treatment itself. Maintenance drugs are most effective when part of a program. They are not a substitute for a treatment program.
Treatment should focus on finding solutions, not prolonging the suffering. Drug and alcohol addiction treatment should come from a holistic approach that addresses more than just physical ailments. Holistic treatment focuses on providing extensive and personalized therapy, combined with physical and emotional heal. If insurance companies want to focus on combining rational medical resources with comprehensive treatment, then this could be a great thing. However, if the focus becomes a quick-fix drug option opposing a full recovery through treatment, it only adds to the danger.
Maintenance drugs have support from the recovery community, but typically they must be accompanied by therapy and other means of treatment. Maintenance drugs are just that- drugs. They are often powerful narcotics, and are true to their title- “maintenance,” not a permanent solution.
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Author: Justin Mckibben
Many months back, when President Trump was still on the campaign trail, he was asked about the opioid epidemic in America during a Q&A in Ohio. He said the solution was about cutting it off at the source through the southern border. President Trump continues this narrative in a more recent solo press conference, suggesting the United States is becoming a “drug infested nation,” and he added,
“Drugs are becoming cheaper than candy bars.”
So what is President Trump’s plan to fight addiction, and will it help addicts?
President Trump on Cartels
By now we all know President Trump believes there is a direct correlation between the drug epidemic in America and what he calls an epidemic of illegal immigration. In the past he has pointed to the infamous border wall as the answer to cutting off the heroin trade into America, which he seems to believe is the primary source of the problem. During his press conference he adds,
“We’ve ordered the Department of Homeland Security and Justice to coordinate on a plan to destroy criminal cartels coming into the United States with drugs,”
President Trump went on to say,
“We have begun a nationwide effort to remove criminal aliens, gang members, drug dealers and others who pose a threat to public safety.”
To be fair, we must acknowledge the relevance of cartels in the drug trade. Since the 90’s some statistics show that the primary supplier of heroin to North America is pretty consistently Latin America and Mexico.
However, to believe that Mexican cartels are the only element of the opioid epidemic is a mistake we can’t afford to make. And blaming an entire country for drug dealers and gangs is a bit out of step with the history of drugs and gang violence in America. While it cannot be denied that Mexican cartels have a role in all this, solving the addiction problem is a lot bigger than that. Besides the fact that heroin is not only from Mexico, heroin is definitely not the only problem.
President Trump on China
For example, what do you know about fentanyl? That is, the incredibly dangerous opiate that has created such a overwhelming panic as a result of steep spikes in overdoses and deaths. Did you know it originates from Chinese suppliers?
According to some lobbyists, there are some clues that could imply President Trump plans to prosecute drug traffickers and close shipping loopholes that include drugs coming in from China and other areas.
So far, however, there isn’t much mention out there about these ideas. It seems the majority of the statements being made openly are singling out Mexico. It might be time to talk more on these other areas they plan on addressing. There is some value to stopping these dangerous drugs from getting here, but we also have plenty of problems here already.
President Trump on Opioid Epidemic
President Trump did release details during his campaign about his intentions for taking on the opioid epidemic, stating he plans to:
- Increase Naloxone access- the opiate overdose medication
- Encourage state and local governments to provide treatment options
- Speed FDA approval for abuse-deterrent painkillers
Yet some people are concerned because there hasn’t been much more talk about this since late in the campaign trail. President Trump has referenced a move to expand access to drug courts and raise the cap on how many patients that doctors can prescribe medication-assisted treatments. These may be very effective strategies for providing multiple opportunities for exposing addicts to recovery. But we aren’t hearing enough about those either. When the subject comes up, we should hope for more accurate information to know if addicts will get this help, instead of hearing about immigration.
Again, many still want the President to talk more openly about the contribution made by Big Pharma and prescription drugs to the issue, specifically concerning the opiate epidemic. We can only blame so much of our problems on outside influence. We have to hold our own drug companies accountable.
President Trump and Big Pharma
Trump did say throughout his campaign he would be fighting the Big Pharma companies in order to get rid of outrageous price-gouging on medications. He made a statement at one point that,
“Pharma, pharma has a lot of lobbies and a lot of lobbyists and a lot of power and there’s very little bidding on drugs,”
“We’re the largest buyer of drugs in the world and yet we don’t bid properly and we’re going to start bidding and we’re going to save billions of dollars.”
This much isn’t off base. According to the Center for Responsive Politics, drug companies and their industry allies spent more than $186 million lobbying for their interests in a year, and $1.12 billion since 2012.
Yet, the Republican Party did a great deal in 2003 under President George W. Bush to prevent federal government from interfering in negotiations between drug companies and pharmacies that participate in taxpayer-funded Medicare Plan D prescription drug benefits.
Hopefully, having a Republican Congress that isn’t constantly at odds with their President will help things move along easier; especially concerning healthcare reforms. So beyond making drugs cheaper, the question becomes what can we do about preventing dangerous and addictive drugs from getting even more out of control.
ACA and CARA
With healthcare reform, many addiction recovery advocates insist that the Comprehensive Addiction and Recovery Act (CARA) should be a priority. Many say the CARA is the most significant federal legislation pertaining to addiction in years. Still, it does not include a specific allowance of funding for the programs it has created.
Once CARA is funded, more programs will be put in place to help fight addiction. Without the funds it is a Cadillac with no engine or wheels.
Then there is the major point President Trump ran on; repealing the Affordable Care Act (ACA). This action could eliminate coverage for many Americans in recovery who had previously been uninsured. Specifically, if the government repeals the ACA without a plan to replace it or to maintain coverage for those depending on it. If President Trump and the GOP come up with a program to replace it, we may still avoid this tragedy. Still, as it stands, the idea makes plenty of people nervous.
For instance, Medicaid, the federal-state insurance for low-income people, payed for about $60 billion worth of mental health services in 2014. That assistance is now expected to shrink as a result of healthcare reforms under President Trump.
After Republicans have pledged to make some major cuts in federal spending, there is still hope out there that agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) would not see their funding severed. This would potentially be another devastating blow to the efforts already in place to battle addiction in America. Will President Trump defend these programs to help addicts?
What Will Help?
Some of the ideas this administration mentions do have some hope behind them. My opinion, we might want to hear more about the expansion of treatment options and access to life-saving resources. The strong focus on border control and President Trump’s cries for “law and order” and aggressive investigations sound extremely reminiscent of the War on Drugs that failed so many families and people suffering.
As the former drug czar Michael Botticelli stated,
“Any drug policy that’s going to be effective has got to be based on science and research,”
So President Trump has his work cut out for him, but some still say we need to see more being done with healthcare and providing resources. More advocates want to hear plans on healing people; on how we plan to save lives. Assure people by taking real action to show they will not be without insurance or treatment.
So this does not mean to say the President’s plans are not good. Essentially, we just want to hear more about them besides borders. If his plans do involve expanding current resources, and if the ACA is effectively replaced; if we see adequate funding appropriated for the CARA and if we make this about more than just immigrants and law enforcement, then the plan could make a difference. So far only time will tell.
Drug abuse and addiction is a devastating and deadly disease, and providing effective and compassionate treatment makes a lifelong difference. 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
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Author: Justin Mckibben
In 2008 the Mental Health Parity and Addiction Equity Act passed. Ever since then health insurers and employers have progressed toward improving coverage for mental health and substance abuse issues. One step in the new direction includes insurance plans no longer charging higher copays or separate deductibles for mental health care, but beyond that there is more to be done.
In March President Obama announced the establishment of a task force focused on further studying and improving the scope of coverage for mental health to ensure that patients with mental illness and addiction would not face discrimination in their health care.
The task force recently submitted a report in which they have made a series of recommendations. Part of this initiative called for $9.3 million in funding to improve enforcement of the federal parity law. Taking a closer look at the report, this is important news for those trying to find help.
The Task Force Report
As part of the report, the task force authors touch on how the lack of effective treatment impacts more than just the costs of treatment and actually creates more issues and more costs down the road. The report states:
“These disorders affect society in ways that go beyond the direct cost of care. Without effective treatment, people with these health conditions may find it difficult to find or maintain a job, may be less able to pursue education and training opportunities, may require more social support services, and are more likely to have their housing stability threatened.”
This is the truth. People who fail to receive quality care for substance abuse and addiction often end up facing multiple hurdles later on. The fact is there are significant problems with the parity law. But some are probably asking, what is parity and what does it mean for substance abuse?
Parity Law Explained
Mental health parity means equal treatment of mental health and substance abuse disorders in insurance plans. When an insurance plan has parity, it means you should get the same benefits for mental health or addiction treatment as you do for other chronic conditions.
For example: If your insurance plan provides unlimited doctor visits for diabetes, they must also offer unlimited visits for depression or schizophrenia.
However, parity makes no guarantee for quality of coverage. Many would argue that “equal” coverage does not translate to “good” coverage. So if your health insurance is limited, your mental health coverage is also limited.
The rules of parity law can be a little confusing, and there are some big problems with regulation.
Task Force Recommendations
In order to get a comprehensive idea of how to address problems with parity, the task force reached out to several sources. They received 1,161 public comments from:
- State regulators
Based on the findings, the task force has enacted some new strategies to work toward move effective parity regulation. Some of these include:
- The Centers for Medicare & Medicaid Services is awarding $9.3 million to states to help enforce parity protections.
- A new government website will help consumers identify the right agency to assist with parity complaints and appeals.
- A new consumer guide to help patients, families and providers understand their rights and look into whether they have experienced a parity violation.
- The Department of Labor will report each year on investigations into violations.
The federal task force also recommended the government increase its aptitude to audit health plans for parity compliance. Also they suggest the same for the Department of Labor when assessing civil monetary penalties for violations.
Opinions on Parity Plans
Former congressman Patrick Kennedy is one of the authors of the 2008 parity law. After examining the task force’s report he said the actions were a step in the right direction, but much of it still places the burden of real action on the patients. Kennedy insisted that the next administration will need to be vigilant in enforcing the parity law.
Both the America’s Health Insurance Plans and the American Psychiatric Association showed support for the report and its recommendations.
Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, has an even more direct stance on the matter. Miller says,
“Separate is not equal — mental health is core to health. People do not see themselves as a disease or a select health benefit, but rather a person who has needs. Benefits and payments should follow the person, address their needs, and address the whole of their health.”
Miller’s idea is that if we want the treatment coverage to be absolutely equal, why not just eliminate any borders of distinction?
What does it all mean?
Essentially, the federal task force is fighting to assure that insurance coverage for mental health and substance abuse be more available and more strictly enforced. At the end of the day, the government realizes that allowing insurance companies to skimp on the bill when it comes to treating these kinds of disorders is not tolerable, and that people should be made more aware of their rights to coverage.
State and federal laws may also be different in regards to protection of parity. People should be educated on how this affects them and how to make sure their insurance providers are offering them the quality and equality of care they’re entitled to.
People struggling with substance abuse and addiction deserve comprehensive and compassionate treatment, and these actions are an important step towards making treatment more available.
Substance abuse should be getting the attention is deserves. Hopefully the discussion on drug policies will gain priority in the upcoming months. If you or someone you love is struggling with substance abuse or addiction, please call toll-free now.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
For those who don’t know, if someone relies on Medicaid to provide them with the coverage they need for healthcare, then for years now their only option when it comes to getting treatment for drug or alcohol addiction was almost always to depend solely on money from state and local sources. Because of this, a lot of people out there struggling with addiction have not been getting the treatment they needed.
The huge news coming over the wire now is there is now hope for a histrionic shift as the federal government is considering making a contribution to providing treatment funding for those who desperately need it but lack the coverage.
A new proposition would have the agency that governs Medicaid covering 15 days of inpatient drug and alcohol treatment per month for anyone enrolled in a Medicaid managed care plan.
Is this enough time?
Now the big debate being brought out here is that this isn’t nearly enough time for people suffering from substance abuse and addiction to actually make progress that can sustain longevity. The question becomes- is 15 days of treatment paid for by Medicaid enough?
According to the National Institute on Drug Abuse, in its guide to drug addiction treatment:
Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length.
A lot of people who have experienced drug and alcohol treatment can tell you that 15 days is barely a drop in the bucket. A lot of residential inpatient treatment programs last between 30 and 90 days, and some long term treatments last for months at a time… and people still struggle sometimes after completing some of these programs.
The hidden element here is also how active and willing an individual is to actually participate and follow through with a recovery plan… lets just get that out there too.
At any rate, a professor at Boston University’s Clinical Addiction research unit, Dr. Jeffrey Samet, stated the funding for research that gets at the optimal length of an inpatient stay, in terms of effectiveness, has been slim so there isn’t extensive data. With the lack of good data, private insurance plans are ambiguous and can have a firm contrast in terms of how many inpatient days they will cover.
So while it may not be the most documented issue facing addiction treatment, it definitely makes sense to assume the more time you can dedicate to healing and learning in a safe environment is better, in my experience, for long lasting recovery… but it is still no guarantee.
It’s something to think about…
While some would say 15 days is not enough to really make a difference, every little bit counts toward changing lives. In my personal opinion I think it’s important to be grateful that it’s a new opportunity for some, especially since Medicaid hasn’t funded residential treatment programs at all up until now.
15 days may not change everything… but then again it might. It’s something to think about.
Cindy Mann, a former top administrator at the federal Centers for Medicare and Medicaid Services, which governs Medicaid, stated:
“Maybe it’s half a loaf for someone who needs 30 days. But it’s half a loaf of new federal dollars that could be available.”
Medicaid will start covering at least some inpatient treatment, which is a big step in the right direction. Experts also insist that doctors and patients should always consider continued treatment in intensive outpatient programs, which can be highly effective for some people and are less expensive.
Mann also pointed out that this proposal still allows state governments to pay for as much treatment as they think a patient needs, which has been going on all along already.
“The state and the locals are completely free to finance that stay if they think it’s the right place for somebody to be.”
States still have even more power to put together innovative treatment programs to apply for more federal money, so in reality this new campaign is just more assistance being thrown into the mix. The insurance coverage side of getting effective addiction treatment has been a road block for a lot of people to get the help they need, and with the demand growing more organizations are pulling resources to lend a hand in saving lives.
Most full-coverage insurance plans include payments for addiction treatment, but not everyone has this kind of insurance. As the fight against addiction becomes more widely recognized and understood, more elements are changing to provide opportunities for those in need. Palm Partners proudly specializes in holistic healing for drug and alcohol treatment, so if you or someone you love is struggling please call toll-free 1-800-951-6135