There is No Treatment for Addiction Unless There is Insurance Coverage for Addicts: the ACA and Opioids
One thing that hampered Obamacare from the very start was false advertising. Though the Democrats spoke of healthcare reform, the Affordable Care Act (ACA) was never that; it was only ever changes to insurance — namely, who was eligible for coverage with government help; how insurance could be purchased by unemployed, self-employed, or small businesses; and some new rules that private insurers must abide by in each plan offered.
While ACA’s proponents tried several bureaucratic jiujutsu moves to take down high costs of healthcare in the United States, Obamacare left the supply side of healthcare virtually untouched. Instead advocates hoped that getting a significant chunk of people covered, or covered better, would eventually drive down the costs healthcare for all.
“Eventually” is a long time to survive the disjunctures between how the plan was presented to the American people and its actual operation, especially for those who purchased healthcare on exchanges and were most vulnerable to its flaws. High deductibles, annual premium increases, and ridiculous spikes in the cost of commonly prescribed drugs like insulin left many recipients with the impression that Obamacare was a faulty intervention, rather than a fatefully limited one.
But there is one area where the distinction between healthcare reform and coverage speaks in favor of the ACA: treatment for substance use and disorders.
In providing people the tools for recovery, supply-side only interventions simply do not make sense, or do nearly as much good, as access to insurance all that comes with it: primary and specialist screenings and care, counseling, and drug coverage for any prescriptions for drug maintenance or to manage withdrawal.
Insurance coverage places treatment in the hands of the only person who has any power to make it effective: the person who needs it.
This is no mere caveat. Today the United States faces the largest drug crisis in its history, and the concentrated nature of opioid overdoses means that several states and communities have endured a public health crisis of staggering proportions. People who live in or pay attention to these places often refer to them as “opioid-ravaged.” It is already the case that many of these communities confront obstacles in making recovery more feasible: patients living in remote areas struggle to stay in contact with their physician or support groups, and can realistically only manage prescriptions filled on a monthly basis.
What will their treatment options look like if their closest point of contact is not any doctor but a specific treatment center? How will their care be affected when it is not theirs by right? If the ACA is repealed, recovery for indigent and working class addicts will be dictated by the murky world of treatment facilities, known to have both many credible and many dubious outfits. Personal whims or religious doctrine may supplant medical protocols, and patients will be forced to view their medical care not as a right but as an act of charity.
This is an absurd and inhumane course to chart at any point in time, but especially so in the midst of an extraordinary and difficult public health crisis. ACA repeal will jeopardize convenience and care for the patients who need it the most at a time when we can afford the least. Brain receptors for those dependent upon opioids take two full years to recover normal function, and very often this process must be accompanied by prescriptions that taper in dose to ward off cravings. This base protocol involves a length of time and treatment path best managed by a doctor and a patient, period. That is precisely what ACA repeal will take away for hundreds of thousands of patients.
The government can fund all the recovery programs in the world, and Republicans ready to cut the ACA now rebuff concerned constituents by promising to bolster block-grants to states for treatment programs. Showering money on programs to treat addiction will not matter if insurance coverage for addicts is taken away. Naturally, funding more treatment programs will help some to enroll in them, just like, as ACA designers hoped, more insurance will ultimately help to bring healthcare costs down. But neither is the best tool to address the problem that is most pressing.
Like their Democratic counterparts, Republicans who present treatment funding as adequate substitute for insurance coverage are guilty of “false advertising” — only this time, with even more dire consequences. After all, Democrats who billed the ACA as healthcare reform set themselves up for disappointment from those in sticker-shock, frustrated that good and reliable care remained so expensive and, for some, out of reach. This proved a costly mistake. But Republicans who offer block grants in lieu of insurance coverage will be able to measure the true extent of their miscalculation only in coroners’ reports.