Health Insurance Reform Threatens Treatment Options for Substance Abuse
Since its passing in 2010, the Affordable Care Act (ACA) has been a controversial topic across the country. The plan, which was designed to create a healthcare system in America which was more accessible and affordable for the millions of Americans which did not have access to healthcare, was welcomed as a blessing for many people who had significant healthcare needs such as treatment for substance abuse and other chronic diseases but didn’t have reasonable access to health insurance. Not everyone felt it was the right answer however and many have been calling for a replacement bill since the day it was made law.
Now, over seven years later with a new President in office the government is looking to again reform the American healthcare system by repealing the Affordable Healthcare Act and replacing it with something that has the potential to bring us backward, not forwards. While the ACA certainly is not without its problems, one thing which cannot be disputed is the fact that its implementation has drastically reduced the number of Americans who have no health insurance coverage. This change has significantly altered the way that people are able to access healthcare in this country, allowing millions of Americans to receive healthcare for conditions that they otherwise would have been forced to leave untreated.
While the treatment of substance abuse is only one of the many issues that the recent proliferation of healthcare has helped, it certainly has been one of the most significant. Addressing the continually worsening problem of addiction, particularly to prescription opiates, which has been gradually overtaking the country. Substance abuse treatment is something that is typically covered by health insurance and now that millions more Americans now have health insurance, those who struggle with the serious disease have the ability to get much needed and often times life-saving treatment.
Millions of Americans have become insured
Prior to the ACA being signed into law by President Obama in 2010, there were a record 48.6 million Americans with absolutely no health insurance coverage, which was 15.7% of the population at the time. This was a massive section of the population which was relegated to either receiving no healthcare, going to the emergency room or paying absurdly high amounts for personally funded healthcare. Those almost 50 million Americans had access to only the most basic healthcare for essentially only emergency situations, more specialized forms of medical treatment for things like substance abuse were all but impossible.
As the number of uninsured Americans grew by about 10 million from 38.7 million in 1999 to 48.6 million in 2010, the country began to call for a healthcare insurance system in this country which was more reasonable and accessible for the millions who did not have traditional routes to health insurance. Before the ACA was signed into law, most Americans got their health insurance through the company that they worked for. However, for those that either worked for companies that did not offer the benefit or for those who were unemployed the options for health coverage were slim, and the few options they did have were typically incredibly expensive.
The signing of the ACA into law addressed a few different issues which were contributing to the massive number of uninsured Americans, the most significant being the introduction of regulated health insurance exchanges. These exchanges allow for Americans to purchase health insurance coverage privately, choosing the policy which works with their specific situation. Regulation on these exchanges also attempted to keep costs down for both individuals and insurance companies as the Federal Government allotted money to subsidize costs for both of these parties.
This one major change was the largest reason why the number of uninsured Americans dropped from its peak of 48.6 million in 2010, the year the bill came into effect, to 28.6 million in 2016. Approximately 20 million Americans have health insurance coverage today at least in part due to the Affordable Care Act. For those individuals this means that regular doctors’ visits for routine preventative medical treatment is not a pipe dream but a real possibility. More intensive and specialized forms of medical treatment like substance abuse treatment, something that was largely impossible to receive for those without any form of health insurance in the past, is not much more widely available due to the fact that so many more Americans now have health insurance coverage.
Healthcare reform threatens public and private insurance
While the most obvious threat that the current push to repeal the ACA causes for American’s health insurance options comes in the forms of massive deregulation of the current health insurance exchanges, another large issue are the proposed changes to Medicare and Medicaid programs across the country. Medicare is the countries federal health insurance program for people over the age of 65 as well as certain younger people with disabilities. Medicaid on the other hand is a federal/state partnership which is designed to provide health insurance for low and no income individuals and their families. Together these two programs provide health insurance for 26.3 % of the population in American as of 2016.
This number has grown since the passing of the ACA due to the fact that the bill has specific provisions allowing individual stated to opt to expand their Medicaid coverage, allowing more people to take advantage of these health insurance programs. While not all states opted to expand, the increase in the number of those covered by Medicaid was still quite substantial. This was the second big factor which contributed to the massive decrease in uninsured Americans.
Unfortunately, current proposals to repeal the ACA include it being replaced by bills which will drastically reduce funding for both Medicare and Medicaid across the country. This will almost certainly reduce the number of Americans who are able to receive this type of coverage, not to mention the potential decreases in the quality of care those who still have insurance under these programs will also experience.
The currently proposed new legislation, while vague, will almost certainly increase the number of uninsured Americans. While most proposals do not call for the complete removal of the health insurance exchange, they do call for massive deregulation of it. Backers of these bills claim that this decreased regulation will allow for health insurance companies to offer more affordable and competitive health insurance policies, but exactly how this will occur is a topic of controversy which most opponents of these proposed bills claim is simply not the case. The regulations currently in place within the marketplace were designed specifically to keep the insurance companies from placing absurdly high costs on premiums for these self-funded insurance policies, but if those are removed then the health insurance companies will be free to charge whatever they please for the policies. This has many experts predicting a mass exodus from the current private health insurance exchange, which would again leave millions more Americans without health insurance coverage.
The potential impact for substance abuse
While a lack of healthcare options for millions more Americans is going to be a massive problem for society no matter what, there is a particular situation that has been emerging within our country that cannot be adequately addressed if we return to the old policy of having a large percentage of the population uninsured.
The opiate epidemic, which has been growing steadily for at least that last decade, has reached levels so significant that many are calling it a national emergency. More and more Americans are not only becoming addicted to opiates like prescription pain killers and heroin every day, but hundreds of these opiate addicts are dying from fatal overdoses each day.
The origins of the epidemic are quite complex and widespread, however one statistic which highlights the scope and scale of the problem quite easily is the number of painkiller prescriptions which are being written across the county each year. These prescription painkillers which are being prescribed by doctors are the most common reason that people find themselves dependent and/or addicted to opiates. While the numbers of these prescriptions vary quite drastically from one state to another, the simple fact is that even in the states which have the fewest number of painkiller prescriptions the numbers are significant and continuing to fuel this particular substance abuse problem.
While the state with the fewest prescriptions per 100 people is Hawaii at 52, it is still important to point out that this is more than one prescription for every two men, women and children in the entire state. On the other end of the spectrum, states like Alabama and Tennessee topped out at 143 painkiller prescriptions per 100 people which is significantly more than one prescription for every individual in the state.
While some recent attempts to stem the tides of this epidemic have been met with at least moderate success, the fact of the matter is that opiate addiction requires some form of substance abuse treatment in order for it to be stabilized. Substance abuse treatment however is not a quick and inexpensive form of medical treatment and these high costs for effective treatment mean that most people who are to receive this often times lifesaving treatment for substance abuse have some sort of healthcare.
The recently decreasing number of Americans who do not have any form of health insurance coverage has been a blessing for the tackling of the opiate epidemic as more people than ever have realistic access to these forms of substance abuse treatment. However, legislation which would again increase the number of uninsured Americans would make it more difficult, not less, for those struggling with substance abuse issues to receive treatment.
This lack of realistic and effective treatment options for a growing number of Americans who are finding themselves addicted to opiates would be a major blow to the already unwieldy opioid epidemic which is spiraling out of control. The very miniscule, albeit tangible, gains that lawmakers and treatment professionals have made to address the problem in the last couple years would be all but wiped out if millions of Americans were suddenly no longer covered by health insurance, effectively eradicating their options for substance abuse treatment and recovery.
The opioid epidemic is only one small, yet important, example of the turmoil that repealing the ACA has the potential to create. Healthcare is an issue which, on the surface, may seem like an individual issue which doesn’t have further reaching societal repercussions. However, when there are large swaths of the American population who do not have health insurance coverage or adequate access to healthcare, their lack of treatment can begin to have negative impacts on society as a whole. The current opiate epidemic is a perfect example of the benefits of as many people covered by some form of health insurance.