The following article is part of a continuing series of articles examining the effects of illegal drugs in Fayette County.

Under the Affordable Care Act, all Americans are to be insured, and addiction treatment is one of the key areas each policy must contain. In fact, under Act 106 of 1989, all group insurance policies needed to include at least minimal coverage for addiction treatment.

So everybody has insurance for addiction treatment, right?

“Everybody doesn’t have insurance. Just because it was mandatory to have enrolled doesn’t mean everybody did,” said Jana Kyle, executive director of the Fayette County Drug and Alcohol Commission. “There were some people who were concerned it was going to be too expensive and the penalty was cheaper.”

Kyle said the registration process was intimidating for some people, with the cost of the insurance not known until the end of the process. Some people, Kyle said, ended up with insurance policies they may never actually use because of high deductibles and co-payments, whether they have an individual insurance policy or insurance through their employer.

“We’ve had some instances of people who the Affordable Care Act was a positive influence on them for treatment; it’s made it affordable and reduced their co-pays,” Kyle said.

There is also that group of people in the midst of their addiction who either never signed up or opted for a low-cost, low-coverage policy.

“If you’re in addiction, odds are you’re not going to select the best insurance plan,” said Deb Beck, the advocate with the Drug and Alcohol Service Providers Organization of Pennsylvania.

Beck was instrumental in the drafting of Act 106 of 1989.

“There was a key provision that went all the way to the Supreme Court, and that’s who makes the decisions,” Beck said.

The law, as upheld by the courts, allows a licensed physician or psychiatrist to make the decision of whether a person requires residential or out-patient addiction treatment. It is not something determined by the insurance provider. A companion law, Act 152 of 1988, calls for parity between treatment coverage for addiction and treatment coverage for medical/surgical reasons. Beck said a big issue, whether under past insurance regulations or under the Affordable Care Act, is enforcement of the policies and getting insurance companies to actually pay for treatments that are covered.

Aaron Zolbrod, president of the Health Insurance Store in Connellsville, said that while all new insurance plans sold include addiction coverage, individuals buying insurance prior to the Affordable Care Act usually opted for plans without that coverage.

“In the past most of the plans we sold did not include addiction coverage, inpatient or outpatient, for individual plans. Most employer plans did cover it,” Zolbrod said. “Rehab is super expensive and suboxone can be $500-$600 for a 30 day supply and the insurance companies didn’t want that expense.

“One of the negatives people have said about Obamacare is ‘Hey, I don’t need that,’ and premiums have gone up a little bit,” Zolbrod said.

Beck said one in four families is affected by addiction, with untreated alcoholics making up the largest number of untreated addicts.

“Most people become addicted over time. They have it, but they don’t know they have it,” Beck said. “People are in denial. They stay out of treatment when they should be coming in. It’s a progressively fatal disease. The recovery rate is astoundingly high if people get the treatment they need.”

Beck said there are an estimated 800,000 untreated addicts in Pennsylvania.

“We under-treat addiction in this state. Not treating addiction costs more than treating it,” Beck said, noting that the increased costs are not only in the criminal justice system, but in the loss of experienced members of the workforce as well.

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(1) comment

Luigie

This problem with the Affordable Care Act and all other problems with insurance coverage in America are due to the fact that these policies are free market products to be sold for profit not to provide healthcare for America.

There is a PA Healthcare plan that made it to committee under the Rendell years. After Corbett and this group of legislators came to power in the last election Pa Senate Bill 400 was shelved. It is paid for by a 3% wage tax on all employees and a 10% tax on all employers. At present the rate is 10% on employees and 30% on employers. This present standard only applies to employers who provide insurance. Senate bill 400 will provide all needed healthcare from the day of birth to the day of death. The State is only the payer and has nothing to do with doctor’s hospitals or any healthcare provider as far as control or choice is applied. A cost study has been done and the study finds that this bill will cover everyone and save on the cost of healthcare for people and the State. It will make sure that all healthcare providers are paid fairly and there provisions to help create primary care physicians and clinics.

So why are we entrapped in greed based free market systems for the profit of the few a peril of those in need of healthcare.

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