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people living with substance use disorder will lose some or all of their health insurance coverage if Obamacare is repealed.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
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.
There has been a lot of debate on whether or not the Affordable Care Act (ACA), dubbed “Obamacare,” is a good thing or not. And really, it depends on who you ask. One thing that can’t be denied is the ways in which Obamacare will change the face of substance abuse and addiction treatment.
Daliah Heller, a consultant working on issues of health care and U.S. drug policy reform, predicts that one of the most important changes stemming from the ACA will be its impact on cultural ideas of what addiction is. In a nutshell, Obama’s health care act protects – in federal law – that substance abuse is, in fact, a medical issue and not the result of poor morals, nor is it a criminal justice problem.
That reflects a greater societal change, as the country as a whole has gotten over some of the stigma it once held for substance abuse, Alden Bianchi, an employee benefits attorney who composed a report on the final regulations for the National Law Review, said. “This is a shift that has taken place over generations,” he said. “It’s not just a matter of a couple of years and a couple of laws.”
“If we view ACA as this document that is now federal policy…it’s sort of de facto recognition that it’s not a criminal justice issue. It needs to be addressed as a health issue.”
Heller added that the ACA changes the federal definition of addiction, clearly addressing it as a healthcare issue, which may even lead to decriminalization.
#1: Obamacare Will Cover Addictions
First, the ACA is a huge step toward getting insurance plans to cover addiction treatment. The new legislation prohibits medical insurers from denying coverage due to pre-existing conditions, and this includes substance abuse.
One of the most important changes being made as a result of Obamacare is the expansion of parity rules. Parity means that insurance plans must cover mental health and substance abuse treatment at the same level as regular medical care.
Heller explains, “So, for example, if there are two medications available for a particular condition, or two types of treatment,” you have to have “the same level of treatment available for mental health and substance abuse disorders in that plan.”
This is huge because, according to estimates from the U.S. Health and Human Services Department, it will give approximately 32 million Americans new access to substance abuse and mental health treatment. Furthermore, the HHS estimates that it will expand mental health and substance abuse benefits for an additional 31 million Americans.
#2: Obamacare and Criminal Justice
Perhaps one of the most profound effects the ACA will have is on addiction healthcare coverage in the criminal justice system. By default, prisons and jails end up treating a large portion of the U.S. population that has substance abuse problems. The ACA could help change all that.
Christie Donner, executive director of the Colorado Criminal Justice Reform Coalition says, “Under the old model, really, poor people didn’t have access to substance abuse or mental health treatment—unless it was through the criminal justice system,” which has been convening a panel of criminal justice and health care representatives to plan how to go about implementing the ACA.
First, lower-income people can get access to health coverage due to the overall expanded insurance access, and “without [them] having to be involved in the criminal justice system at all,” Donner said. And this is huge because a large part of the prison population is made up of people of lower-income backgrounds.
Second, prisoners with substance abuse problems do not get the benefits of something called “continuity of care,” which is the guaranteed on-going medical treatment that is enjoyed by other populations. Basically, prisoners arrive in lock-up with substance abuse issues, receive basic treatment, then, when they leave the criminal justice system, they lose access to medical care. According to Donner, the ACA can continue to cover these individuals after their sentences.
Another way in which the ACA will shape addiction treatment when it comes to the criminal justice system is that the extra federal monies (through Medicaid) could help criminal justice agencies expand treatment access to prisoners who are currently incarcerated – programs such as residential substance abuse treatment, as well as alternatives to imprisonment and an overall improved quality of care.
If you or someone you love is struggling with substance abuse or addiction and is seeking treatment, please call toll-free 1-800-951-6135.
As the government enters the 9th day of the partial federal shutdown, tempers are running high.
Some may be wondering how the shutdown will affect Obamacare. Short answer: It won’t.
One of the great ironies of the ongoing government shutdown is that most Obamacare funding, the issue at the heart of the battle, won’t be affected by the spending freeze. The funding for the Affordable Care Act is a permanent appropriation — meaning it was approved in a prior session of Congress (in 2010, when the act was passed) and doesn’t have to be approved again.
Indeed, the insurance marketplaces or exchanges created by the Affordable Care Act (ACA) have been open for business for a week.
Several House Republicans, including some who started the fight, have admited that shutting down the government won’t stop Obamacare.
“We probably can’t defeat or get rid of Obamacare,” Kentucky senator Rand Paul has said.
Sen. John McCain said that it is “not rational” to think the Senate will vote to defund Obamacare.
Even Sen. Mike Lee (R-Utah) who has claimed credit for kickstarting the effort to use the federal budget as leverage to halt funding for Obamacare, a move that led to the impasse and the government shutdown, has realized that the effort is futile.
“Let’s leave Obamacare for another day and not hold hostage the vast majority of government functions,” Lee said.
This is good news for those in need of addiction treatment.
The Affordable Care Act (aka Obamacare) recognizes drug addiction and alcoholism as chronic diseases that must be covered by health insurance plans, and in so doing marks a major transformation of addiction care.
“I don’t think there’s another illness that will be more affected by the Affordable Care Act,” said Dr. Thomas McLellan, former deputy director of the White House Office of National Drug Control Policy.
The ACA requires insurance companies to provide substance use treatment, and encourages medical providers to screen for problem drinking and drug use while allowing them to bill for doing it.
Currently, just 2.3 million Americans receive any type of substance abuse treatment, which is less than one percent of the total population of people who are affected by the most serious of the substance use disorders—addiction.
By the end of 2014, under the ACA, coverage of substance use disorders is likely to be comparable to that of other chronic illnesses, such as hypertension, asthma and diabetes. Insurers will cover physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation.
If you or someone you love is in need of addiction treatment, please call us at 1-800-951-6135.