We are undoubtedly in changing times. The uncertainty captured in a recent VICE article highlights some of the deep concerns of many individuals around the country about what will happen to their access to healthcare in coming months. Regardless of anyone’s opinions around how to or how not to change the healthcare system, with change is the need to evaluate our collective conscience around how we are caring for the most vulnerable among us.
The debate on healthcare in the United States is one forum where we see the clash of competing voices, namely how we ought to care for the most vulnerable members of our communities. In recent years, the discussion has become increasingly focused on the concept of “access to care”, which was a key cornerstone of the Affordable Care Act (ACA). Regardless of anyone’s position on the ACA, it is undisputable that its implementation raised important questions around what it means to truly have access to high quality health services.
The existence of a healthcare system is distinct from having access to care. Just because there is a healthcare system does not automatically mean that all individuals are able to receive the care they need. This is a beginning point of discussion as to why access to care is so critically important to individuals suffering from substance use disorders (SUDs) – a population historically excluded from access to comprehensive health services through health insurance. This lack of access to care has still deeper, more pronounced effects on populations who are medically-underserved, such as low-income and homeless populations, making it an issue of health equity.
Addiction is a national crisis. With over 20 million Americans suffering from a substance use disorder (SUD), the need for effective, compassionate recovery services for addiction is greater than ever. National attention has been drawn to this issue, along with the need to force a cultural change in how the public perceives addiction – to move away from the longstanding belief that it is the symptom of moral failing and identify it as a chronic disease of the brain that requires medical treatment. In a report issued on November 17, 2016 by the U.S. Surgeon General Dr. Vivek Murthy featured in the November 2016 Huffington Post article, addiction is described as, “…a chronic disease of the brain” and must be treated, “…the way we would any other chronic illness: with skill, with compassion, and with urgency”. Just like hypertension or diabetes, treatment needs to be ongoing, not episodic. We do not provide a lifetime of medication to patients with these disorders and find patients suddenly living disorder-free lives. Treatment for addiction, like any other serious chronic health condition, needs consistent treatment.
Treatment for addiction is health access and equity issue. Low-income and medically-underserved individuals are most at-risk of being completely disconnected from substance abuse treatment options. In 2012, the U.S. Department of Health & Human Services’ Substance Abuse and Mental Health Services Administration reported that 90% of the 23 million individuals, 12 and older, suffering from SUDs did not receive treatment. Beyond a “disease of the brain”, it was also reported that untreated SUDs were associated with significantly elevated risks for developing co-occurring and chronic conditions such as type 2 diabetes, chronic obstructive pulmonary disease, hypertension, depression, anxiety disorders, various cancers, and major psychosis. Lack of access to health services, including those providing treatment for substance abuse disorders that increase risk factors for a host of chronic health conditions, increases health disparities across historically disadvantaged and underserved populations, which is why access to care for SUDs needs to remain a priority within healthcare. It is estimated that people who suffer with SUDs and mental health problems die 20 years younger than those unaffected by these disorders.
Amidst polarized views on healthcare system reform, the discussion around healthcare system reform should include the gains the recovery industry has made since the ACA came into effect. The ACA elevated our healthcare system in the United States to recognize SUDs treatment as a fundamental right that was listed as one of the “ten essential health benefits”, making it a required benefit under all ACA-compliant health insurance plans. It is also important to be reminded that the 21st Century Cures Act signed as a part of the ACA that addressed opioid addiction as a serious health issue won bipartisan support in Congress, which led to the allocation of federal resources to combat SUDs. The question remains: what will happen to this forward momentum if the ACA is repealed?
Many recovery service providers like the CLARE Foundation fear more loss of lives if the ACA is repealed. Our hope is that regardless of the changes that come, that our legislators will continue to hold an uncompromised commitment to preserving, improving, and expanding access to care for SUDs. We are committed to working alongside our partners in advocating for more support for effective and affordable treatment options to ensure that all individuals have access to the lifesaving care they need.
– Lisa Steele, Ph.D – CEO of CLARE Foundation
 Ghitza UE, Tai B. Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act. Journal of health care for the poor and underserved. 2014;25(1 0):36-45. doi:10.1353/hpu.2014.0067.