Addiction Treatment under Obamacare: More Will Get Help but Who Will Provide?

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The Affordable Health Care for America Act was signed into law in 2010.

It comes with a graduated series of changes to the way healthcare is funded in the U.S., and a provision that directly affects addiction treatment will start up in 2014.

Currently, one of the barriers for addicts to obtain treatment is the cost of care. In the strange world of medical funding, those who are wealthy pay cash for top-tier service, and those who are impoverished have publicly funded treatment available. But in the middle, where insurance may not cover substance abuse treatment, there’s a funding gap. Some of this gap will close next year.

How many need treatment?

In the U.S., there is no single number that captures who qualifies as a substance abuser. This is because the behavior is often concealed and surveys do not agree on what constitutes addiction. Other problems arise when the substance is not considered addictive.

A report from the Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services shows that there are as many as 23.5 million adults in the U.S. who have at one time had issues with alcohol consumption or drug use. That gives an estimate of about one in 10 Americans. Further, it’s estimated that only 10 percent of that 23 million is getting treatment.

Under the new rules, treatment will open up for 3 million to 5 million substance abusers. We do not know how many of this group will take advantage of the offer to pay for treatment, but the expectation is that the current treatment capacity will be swamped by the influx.

How much money?

Figures on the cost of rehab and outpatient treatment vary by location and additional diagnoses, but widely quoted statistics put the numbers at about $1,400 for outpatient and $4,000 for inpatient. These are program totals, and programs can vary in length (increasing price) as well as by substance treated – for example, a methadone program is estimated to cost $7,000 for outpatient. “Cadillac” care can break the $30,000 mark for a month-long rehab.

Medicaid does cover 30 days of inpatient treatment and more can be billed as fee-for-service. The main barrier to entry is a recommendation from a primary care physician, not difficult to obtain with a single appointment and interview.

According to Medicaid Interactive:

Medicare Part B helps pay for outpatient substance abuse treatment services from a clinic or hospital outpatient department. Medicare will pay 65 percent of its approved amount for mental health services, and you or your supplemental insurance are responsible for the rest in 2013. You or your supplemental insurance will be responsible for the remaining 35 percent.

Possible consequences

We don’t yet know if our addiction treatment programs can absorb an avalanche of new patients. It takes time to ramp up because bed space, certifications for services and higher staffing requirements are all needed before a treatment program can start up or increase capacity.

In the opinion of many, current services are not meeting scientifically proven standards, including not treating patients long enough (a three-month minimum for inpatient is recommended) nor meeting the entire range of mental health needs (an estimated 60 percent of addicts have a co-morbid condition, such as depression or anxiety).

Will it crash? This is unlikely. There’s no reason that the system won’t be able to treat at least as many as receive treatment now. What may become obvious is that our system is inadequate to handle the real needs of citizens if it sees a sudden influx of new patients.

“We have a system of treatment that was built for a time when they didn’t understand that addiction was an illness,” said Tom McLellan, CEO of the nonprofit Treatment Research Institute and President Barack Obama’s former deputy drug czar.

And that’s where we stand. How well the treatment community responds will determine whether substance abuse shifts to a “curable” societal dilemma or remains a fight to tread water.

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