When federal health care reform takes effect next year, an estimated 3 to 5 million people with drug and alcohol problems will become eligible for insurance coverage. Broader access to addiction treatment is sorely needed, but there is widespread concern that drug rehab centers will be overwhelmed by the number of patients seeking treatment, which could double depending how many states expand their Medicaid programs. Is the concern justified?
The Untreated Insured
Although there is ample reason for optimism, the reality of “Obamacare” could be different than the promise. For millions of addicted individuals, a lack of health insurance has been a barrier to treatment. Millions more have insurance but, because of shame, stigma, denial or other factors, haven’t made the decision to seek help. Thus, even if more people have insurance, the question remains whether addicts will avail themselves of the opportunity to get treatment.
It will likely require education and advocacy before people with substance abuse problems will start flocking into treatment. With greater insurance coverage comes less stigma, and with less stigma more people will seek help, but the process will be a gradual one. This is supported by the experience of states with laws requiring similar treatment for substance abuse as other medical issues, where any increase in use of substance abuse services has been gradual.
For those who do avail themselves of treatment, the next question is: Will treatment actually be available? And if it is, will it be high-quality, evidence-based care?
Without a plan in place, millions of Americans could show up for treatment, insurance card in hand, only to be turned away. In two-thirds of the states, treatment facilities are already at or nearing full capacity. Many addiction treatment programs have experienced budget cuts in recent years, making it difficult to meet the current demand for services, not to mention the potential influx of new patients coming next year.
While many providers are already expanding, there’s a strong possibility that others will not be able to invest in new facilities, staff and services, especially if the full cost is not reimbursed. As a result, patients may sit on waiting lists for months or end up in emergency rooms or urgent care centers for short-term treatment of a chronic illness that requires long-term care.
When these individuals finally get into treatment, the quality of care they receive may or may not meet their needs. Last year, the National Center on Addiction and Substance Abuse at Columbia University released a five-year study showing that most people do not receive evidence-based care. In many programs, services are short-term, one-size-fits-all and provided by minimally qualified addiction counselors. Without adequate planning and funding, quality of care could suffer even more under the new law.
Answering the Call
Nationwide, millions of people are in need of substance abuse treatment. Soon, many of them will be eligible for insurance coverage. This presents obvious challenges, but they are challenges we must meet. For decades we’ve been pleading for improved access to addiction treatment. In some measure, our wish has been answered. Now the question is: Will the treatment system do its part?
David Sack, M.D., is board certfied in addiction medicine and addiction psychiatry. He is the CEO of Elements Behavioral Health, a network of addiction treatment programs that includes Promises, The Ranch, Malibu Vista, The Recovery Place, and Right Step.
