Constance Scharff, PhD: it's a bad time to cut access.
Editor's note:Constance Scharff, PhD, is an addiction counseling specialist based at Cliffside Malibu in Malibu, California and a contributor to MDMag.com.
As details of the Republicans’ proposed American Health Care Act emerge, the addiction recovery community is starting to sound alarm bells. It looks like those who can often least afford health services — the mentally ill and addicted – will lose access to care. These proposed changes are a step in the wrong direction and they could be catastrophic for those in need of mental health or addiction services.
Medicaid coverage, which was expanded under the Affordable Care Act, could move to a block grant system, meaning that fewer dollars will be available for healthcare for the nation’s poorest Americans. Second, the proposed tax credit system will no longer provide credits for those with the fewest resources, but only for older Americans. Both of these actions will limit access to mental health and addiction treatment resources for those who need it most.
The cuts could not come at a worse time.
The nation is in the grip of the worst substance abuse epidemic ever. The number of deaths from opioid overdoses in the United States increased 280 percent from 2002 to 2015. A record 52,404 Americans died from overdoses in 2015, according to the latest data from the Centers for Disease Control and Prevention. Once rare, these avoidable deaths are now more common than auto-accident fatalities or gun-inflicted homicides and suicides.
So far, some popular pieces of the ACA are being retained under the Republican plan. Young adults, under the age of 26, can remain insured under their parents’ health insurance policies. There will be no return to lifetime caps on care. The regulations eliminating “pre-existing” conditions will be kept. Each of these is an important patient protection.
The problem with the Republican plan is funding. The goal of the ACA was to expand access to healthcare to more, nearly all, Americans. The Republican plan eliminates the participation mandate, meaning that the young and healthy will not be required to put their money into the pool. Tax credits for older Americans will not likely be enough to offset skyrocketing plan costs. The Republican plan effectively limits access to care for the poor, the aging, and the ill. Insurance will be too expensive for these groups and Medicaid cannot pick up the slack.
The worst impact would be among our most vulnerable citizens. Addicts, for example, will not likely have access to quality insurance policies, because at the height of their disorder, many if not most addicts cannot work. Medicaid, designed as a safety-net, is scheduled to be partially de-funded by switching from a need-based system to a block grant system. With alcohol abuse costing the nation over $200 billion a year and more than 50,000 deaths caused by overdose in 2015, we can’t afford to de-fund addiction treatment.