Up to 62 million people to receive coverage for treatment
By Ryan Trares
Daily Journal
FRANKLIN, Ind. (AP) — For patients admitted to Tara Treatment Center, the hope is to recover from the disease that shattered their lives.
Alcoholism has cost them their jobs, drug abuse has torn them from their friends and their families, or their addiction has led to arrest or jail time. They are attempting to regain control by working with counselors at Tara at the treatment center south of Franklin.
Addiction treatment rarely is covered by health insurance, and many people cannot afford programs needed to recover and manage the disease. That prevents millions from getting the help they need.
But that will change next year.
Starting in 2014, health insurance companies will be required to pay for substance abuse and addiction treatment. The change means that up to 62 million people will receive some kind of coverage for drug and alcohol problems, ranging from paying for weekly counseling sessions to long-term stays in rehabilitation facilities.
Local treatment centers are encouraged that addiction is being treated more like a disease than a moral shortcoming. But questions remain about what will be covered and for which people, Tara admissions director Jessica Daugherty told the Daily Journal.
“We’re trying to follow along. It’s still not really clear how it’s going to be administered. That hasn’t been defined yet,” she said. “It’s certainly going to increase people’s ability to access services somewhere and at some level. But that’s a whole lot better than nothing.”
The change is part of the Affordable Care Act, passed in 2010 to expand Medicaid and private insurance coverage to more people.
States are allowed to decide whether to make Medicaid available to more people. In Indiana, the General Assembly has not passed legislation to expand that portion, and Gov. Mike Pence has stated that the only expansion would be through the Healthy Indiana Plan already in place, said Marni Lemons, spokeswoman with the Indiana Family and Social Services Administration.
“We have made that request for the Healthy Indiana Plan to the federal government, and we’re still waiting to hear back,” she said. “There’s not much we can do until then.”
That indecision is making it difficult for health care providers to prepare for additional patients, Daugherty said.
But while few solid details have emerged, certain aspects of the law will go into effect regardless of what the legislature does. The Affordable Care Act established 10 mandatory “essential health benefits” that need to be covered by individual and small group insurance plans.
One of those benefits is behavioral health, which includes addiction treatment.
“Addiction, because it is a chronic illness, it’s just like heart disease or diabetes,” said Cindy Schroeder, clinical supervisor at Tara Treatment Center. “The earlier people can get help and treatment, the less overall cost in their lifetime there will be. And it will reduce everyone’s cost because of that.”
The National Institute of Health classifies addiction as a chronic, relapsing brain disease that causes the user to act compulsively. Medical experts liken it to long-term illnesses such as diabetes or cardiovascular disease.
Tara Treatment Center has been helping people manage the illness for more than 25 years.
Patients address the emotional roots that make them turn to substance abuse. Therapists use individual and group sessions to help change behavior and form new behaviors that don’t include alcohol or drugs.
But despite being accepted as a disease by the medical community, addiction and mental health problems still often are excluded from insurance coverage.
That speaks to a greater stigma placed by society on people who struggle with drugs or alcohol.
“A lot of people believe that it’s a behavior of choice, even if it’s not,” Daugherty said. “It’s taken a long time for society to come around to the fact that it is chronic.”
Steps were taken in 2008 after a bill was passed to more evenly treat mental and physical health problems. But those guidelines were never fully formed by the government, meaning that individual health insurance plans don’t have a solid directive to include treatment of mental health issues such as addiction, Schroeder said.
Large employers still have the option to not include mental health and addictions benefits at all, she said. They can still say that it’s not part of the benefit package, but if they do include it as part of their package, they can’t charge premiums different or impose more deductibles.
“They have to treat mental health and addictions like any other disease. But the problem is, they’re not treating it like that,” Schroeder said. “Even though we have parity laws, they don’t really say that they have to pay for hospital detox or residential stay.”
Much of the services at Tara Treatment Center involve a long-term stay at the facility. Research has shown that it takes 21 days to break a habit, said Theresa Matthews, CEO of Tara. Outpatient programs, such as support groups and counseling, are good for determining a problem or preventing a relapse.
But for someone in the throes of addiction, a few days a week isn’t going to solve the problem, Matthews said.
Insurers are reluctant to pay for that type of expensive care, which can cost thousands of dollars. Almost always, the most they’ll cover is partial hospitalization for a few days.
“We’ve had our clinicians say, ‘Does this person have to be dead to get this authorized to stay?’ We’re giving them enough criteria that would absolutely warrant residential care,” Matthews said. “That’s like saying you just did heart surgery on someone, then the next day, send them home to take care of themselves. That’s the same mentality we see with addiction.”
The Affordable Care Act was intended to correct some of those inconsistencies. But because the details of how it will be implemented in Indiana haven’t been determined,
Officials with Valle Vista Behavioral Health System, a Greenwood-based addiction treatment, choose not to answer questions regarding the changes in the law and what it will mean for their facility.
Tara Treatment Center is anticipating an increase in patients to its outpatient counseling and intensive inpatient programs, Daugherty said. Officials also suspect that when 27 million uninsured people start receiving basic primary care, more people will be identified as having addiction problems.
For the staff at Tara, that’s a great start. But when those problems are detected, Matthews is concerned about whether they’ll get the treatment they need.
Those who work in addiction services have a saying, she said. They describe the chains of addiction as being too weak to be felt until they’re too strong to be broken.
“That’s such a true statement. It’s subtle, it’s progressive, and it’s powerful,” Matthews said. “If you can treat something in outpatient or on a prevention stage, that’s a lot more cost effective. But with this illness, by the time people go to seek treatment, it’s too late to prevent the disease.”
