By David Sheff Nov. 13, 2013
After weeks spent offering up increasingly desperate excuses for the glitchy rollout of Obamacare’s insurance exchanges, Health and Human Services Secretary Kathleen Sebelius seemed elated to change the subject, at least for a moment, when last week she announced regulations that will mean that almost all Americans with health insurance will be fully covered for the treatment of mental illness, including addiction, at least as well as they’re covered for physical diseases. The regulations were trumpeted as part of the President’s plans for curbing gun violence, but they have enormous implications for untreated addiction, which alone costs the nation $420 billion a year, mostly in health care, criminal justice and lost productivity.
The new rules are comprehensive, but it’s impossible to know how they’ll be interpreted, monitored and policed. Treating mental illness isn’t easy or cheap, and treating addiction can be even more complex. Research has shown that addicts who drop out of treatment before 90 days have relapse rates similar to those who stay in treatment only a day or two. After 90 days, however, relapse rates drop steadily the longer they stay in treatment. Few physical illnesses require three-plus months in the hospital. Even after a long stint in an inpatient or outpatient program, most addicts require aftercare that may continue for one to many years. Will insurance now pay for those who need long-term stays in sober-living houses or outpatient programs? What if they relapse, which is common for sufferers of this chronic illness? Will insurance pay for another three-month stint? And another? Will they cover addiction medications like methadone or buprenorphine, even though some patients must stay on them for years or even a lifetime (just as some must stay on blood-pressure medication or insulin throughout their
Read more: One Thing Obamacare Can’t Fix: Bad Addiction Treatment