The Republican Health Care Bill and Addictions: Making a Bad Situation Worse
As described in last week’s article, the opioid epidemic continues to ravage the country, although measurable progress is finally being made on the opioid epidemic. At this critical time, Senate Republicans may deal a setback to the field of alcohol and drug treatment by reducing access to treatment. Their bill, misleadingly entitled the “Better Care Reconciliation Act of 2017,” would do this in two ways.
First would be the elimination of the requirement that all insurance policies cover treatment for substance use disorders as one of the 10 essential health benefits. Patients cannot afford to pay for detoxification, rehabilitation, and continuing care out-of-pocket any more than they could pay for a major surgery. Because of decades of “parity” work by advocates in the addictions field, insurance policies are now required to cover the treatment of substance use disorders in the same way as other chronic diseases. Many insurance companies are disturbingly inclined to exclude such benefits – even though there is consistent data demonstrating that it is in the economic interest of the company to provide that coverage – and would likely do this again if the requirement was eliminated.
Secondly, under the Senate Republican bill, significantly fewer people would be covered under Medicaid. The expansion of Medicaid, now the largest health insurance program in the country, has enabled many people to access treatment for their addictions. The bill is expected to eliminate this access.
The bill does attempt to address the addiction issue by allocating funds to states for the treatment of substance use disorders. This provision appears to be a politically expedient attempt to gain the support of senators from states hard hit by the opioid epidemic – rather than the result of a thoughtful policy review based on consultation with public health experts.
The recent history of attempts to formulate and implement national policy regarding substance use disorders effectively and efficiently has been one of two steps forward and one step backward. The passage of the current Senate Republican bill, however, would strike me as two steps backward. There are many other ways in which this bill would degrade healthcare in this country. If you agree, please call your Senators and urge them to vote against it.