As is the case with beauty, what constitutes the correct amount of government regulation is in the eye of the beholder. This issue is significant in the treatment of addiction, and a readjustment of the current direction is a likely consequence of the national elections last week. On election day, a New York Times article summarized “one of President Obama’s last major health care initiatives…stepping up enforcement of laws that require equal insurance coverage for mental and physical illnesses …[to] help combat an opioid overdose epidemic.” But what will addiction treatment in the Trump Administration look like?
Although the reason for this initiative was concern about the upsurge in deaths due to opioid overdoses, there is a broader story. Payment by commercial insurance companies, as well as by Medicare, for the treatment of substance use disorders, has historically been less than for most other diseases. The disparities in coverage have come in many forms. Some are relatively minor, such as a time-consuming requirement for pre-authorization of the medication, buprenorphine (“Suboxone”) for opioid addiction. This requirement persists although it represents an unnecessary addition to healthcare costs with no evident clinical or economic benefit. Other obstacles to treatment appear in the form of limitations on coverage for basic treatment services. The most extreme disparity is the refusal to pay for the treatment of tobacco addiction (except for medication), which continues to cause the largest number of deaths of any addictive substance.
Many of us in the addiction treatment field have spent years trying to persuade insurance companies to cover substance use disorders equitably. While some companies have been responsive, many others have not been. We, therefore, moved on to working with state and federal governments to prohibit discriminatory practices through regulations.
Many years of work by a broad coalition of policymakers and clinicians culminated in the passage by Congress in 2008 of the Mental Health Parity and Addiction Equity Act. When resistance to change persisted despite the law, President Obama established a task force last March to improve the implementation of the Parity Act.
Not all the discrepancies have been eliminated. The announcement by President-elect Donald Trump that healthcare will be one of his top three priorities gave me comfort that the field of medical care will not be ignored. On the other hand, it is unclear what will happen to the hard-won gains made in payment for addiction treatment during prior administrations including that of President Obama. As these ambiguities become clarified over the upcoming months, I will do my best to clarify them here.
If you have questions about addiction treatment in the Trump Administration, contact us.