With Trump’s recent presidency, Republicans have been working hard to repeal the Affordable Care Act (ACA) as per President Trump’s campaign promises. With premiums rising, there is hope among voters that the repeal could make healthcare more affordable. How that will play out for those with preexisting conditions such as cancer, mental health issues or addiction is a different story. The New England Journal of Medicine reported that “In an October 2016 speech [Donald Trump] delivered in New Hampshire, another state hit hard by opioid addiction, he said that he ‘would dramatically expand access to treatment slots’ and “help all of those people so seriously addicted get the assistance they need to unchain themselves.’”
The opioid epidemic is so concerning, that although the ACA doesn’t currently protect or claim to do more for addicts, there is fear that repeal of ACA could be detrimental to those attempting to become sober. According to the Centers for Disease Control and Prevention, “Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses. 91 Americans die every day from an opioid overdose.”
What is the Affordable Care Act and How Does it Help Those Seeking Treatment?
According to the New England Journal of Medicine, “Although the Affordable Care Act (ACA) was not designed with the opioid epidemic in mind, it provides valuable tools for expanding access to medication treatment: major health insurance coverage expansions through Medicaid and the establishment of state health insurance marketplaces, inclusion of addiction treatment as an essential health benefit that existing insurance plans must cover, and requirements that benefits for treatment of opioid use disorder be provided at parity with coverage of medical and surgical procedures. The dramatic rise in opioid use disorders has prompted many states to take a hard look at deficiencies in their current systems of treatment and to leverage opportunities presented by the ACA for addressing them.”
As a part of the ACA, all medical plans need to cover the following essential health benefits. According to healthcare.gov:
“Every health plan must cover the following services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)”
For substance abuse and co-occurring disorders specifically, all plans must cover:
- “Behavioral health treatment, such as psychotherapy and counseling
- Mental and behavioral health inpatient services
- Substance use disorder (commonly known as substance abuse) treatment”
Currently, “Under the ACA, substance abuse treatment will also become part of primary care, and will be focused more on prevention. Substance abuse treatment will also be considered an ‘essential service,’ meaning health plans are required to provide it. They must treat the full spectrum of the disorder, including people who are in the early stages of substance abuse.” This is according to the Partnership for Drug Free Kids organization. Before the ACA, federal benefits such as Medicare and Medicaid would cover inpatient services such as detox programs. However, office visits for after care and therapy for substance abuse was not covered. Compare this to healthcare for diabetes under federal funds, which are covered one-hundred percent.
This currently makes addiction recovery far more affordable than before. Many people have to wait to hit rock bottom before they are given access (often court-mandated), to recovery services. With ACA, those with who need recovery can get it, and those with mental health issues in addition to substance abuse disorder can get the right kinds of therapy. It is treated like any other preventative disease.
Since the new presidency, the big question is: would repeal of the ACA hurt addicts?
How May the Newly Proposed GOP Health Care Law Hurt Addicts?
President Trump’s campaign promises claim that addicts will be given access to services, but the extent of that access was not discussed. According to CNN, “The current version of the Trump-backed Republican healthcare plan would end the Obamacare requirement that addiction services and mental health treatment be covered under Medicaid in the 31 states that expanded the health care program. The GOP plan would instead leave up to states — and their budgets — to decide whether to cover drug treatment and mental health services under Medicaid. That’s a decision advocates say could put the most vulnerable opiate abusers in greater risk, thanks to near-constant pressure on state budgets.”
CNN goes on to say, “Medicaid expansion provides drug treatment for close to 1.3 million people, according to a study by Harvard University and New York University. Drug treatment advocates and a bipartisan mix of lawmakers, some of whom were heartened by Trump’s rhetoric about drug treatment during the campaign, are concerned that the repeal and replace effort now being marshaled by the White House will dramatically alter drug treatment programs at a critical time in the fight against opioid addiction.”
Currently, the largest payer toward substance abuse and mental health rehabilitation is the United States. By cutting Medicaid and Medicare funding under the ACA, people could lose these essential benefits. Rural communities, already limited in their access to healthcare, will likely be hurt the most if ACA is repealed. Rural areas often rely on federal funding for the healthcare of their citizens. The New England Journal of Medicine states, “The ACA’s mental and behavioral health provisions — like the 2008 parity law passed in the prior administration — have enjoyed substantial bipartisan approval, exemplified by unanimous support for these provisions within the Senate Finance Committee, even among senators who opposed the final overall bill. Moreover, the President campaigned on the promise to respond to the opioid epidemic.”
What Addicts Absolutely Need When Seeking Treatment for Opioid Addiction
The number of fatal overdoses from the drugs increased almost five-fold, from 4,000 deaths a year in 1999 to nearly 19,000 in 2014. These numbers include people who illicitly used prescription opioids and those who overdosed on pills prescribed for them.That is more than deaths in motor vehicle crashes. It’s becoming more and more apparent that one major contributor to these outrageous numbers is the amount of opioids prescribed by doctors to patients for pain. This trend has led to patients becoming addicted to prescription painkillers. As their tolerance grows, their need for higher doses of opioids increases.Heroin is far cheaper and easy to obtain. So part of the plan to treat opioid addicts and the nationwide epidemic as a whole is to educate healthcare providers on alternative ways to treat pain. This can prevent an addiction before one is even able to begin.
Seeing addiction as a disease instead of a choice is important to the development of new approaches in recovery for opioid addicts. According to an article entitled “The Genetics of Alcohol and Other Drug Dependence” by Danielle M. Dick, Ph.D. and Arpana Agrawal, Ph.D., “[…] many of the genetic factors affecting risk for dependence on alcohol or other drugs appear to act through a general externalizing factor; however, other genetic factors appear to be specific to a certain disorder. In recent years, researchers have identified numerous genes as affecting risk for dependence on alcohol and other drugs. These include genes involved in alcohol metabolism as well as in the transmission of nerve cell signals and modulation of nerve cell activity.” This is important to note because for many years, it was assumed that addicts were weak or lazy. Now, it’s becoming more apparent that genetic predispositions can put some at a disadvantage for becoming addicts and for relapsing later. These people need extensive, holistic rehabilitation options.
Next, access to affordable in and outpatient detox and rehabilitation is crucial. Rehabilitation should include therapies for coexisting disorders such as depression, anxiety, trauma and ADHD. It’s extremely important to address all aspects of physical and mental well-being in order to ensure long term recovery.
Whatever the outcome of the new presidency and the future of the ACA, it’s important to remember that recovery options are available. They are affordable, and many detox and recovery programs are covered by many kinds of insurance. Getting help is the only way to overcome this dangerous addiction, and it’s one step closer to curbing the effects of this nationwide epidemic.