Coverage, and access

Kady Williams, Devils Lake

As a student in the psychiatric nurse practitioner program at the University of North Dakota, I have some grave concerns about the state of mental health and addiction treatment in North Dakota. I have spent a majority of my nursing career working with individuals with mental health and substance use disorders. I have seen the devastation of addiction, and I have witnessed the benefits of effective addiction treatment. Understanding the problems addiction and mental health issues can cause, I was not surprised to learn that Altru Health System and Grand Forks community agencies identified access to mental health services a priority for improvement.

Addiction, which is classified as a mental health disorder in the DSM IV TR, is one of the leading causes of death and disability in the U.S. As our state population has grown, so has the number of individuals requiring addiction treatment. Not only has the total grown, the number of adolescents and young adults requiring treatment have grown. In addition to alcohol and marijuana (pot), various forms of synthetic marijuana, prescription drugs, heroin and methamphetamine are reported as the drugs of choice.

Unfortunately, this increase in demand for addiction and mental health service comes at a time when the implementation of the Affordable Care Act. As a result, Blue Cross Blue Shield of ND is decreasing the availability of mental health and addiction coverage for most individuals. Blue Cross Blue Shield of North Dakota announced Oct. 1, 2013 that coverage for residential care, which is necessary for many individuals to achieve and maintain sobriety, would not be available as part of its existing coverage, or part of the coverage available from the Affordable Care Act insurance exchanges. The new “light” addiction and mental health plans contain the minimum mandated by the Affordable Care Act, but do not maintain the coverage levels provided in the past, or the coverage necessary to meet the needs of many individuals seeking addiction and mental health services. For those of you breathing a sigh of relief because you have a grandfathered plan, not so fast. The full range of benefits available to you in the past will no longer be available after Jan. 1, 2014.

Residential treatment is a cost effective means of providing individuals with an environment conducive to recovery, where patients can experience sobriety, achieve mental and emotional stability, and develop and practice the skills necessary to return to their community. Effectiveness of addiction treatment has been rigorously studied by the American Society of Addiction Medicine and it has the most widely accepted criteria used to determine the level of care most appropriate to meet individual patient needs. Without insurance coverage for these levels of care, only the wealthiest of our population will be able to access the full continuum of services.

Wasn’t the purpose of the Affordable Care Act to ensure that all American’s have equal access to affordable healthcare? Make no mistake, by limiting the ability to obtain addiction treatment in the appropriate setting will not only impact those vulnerable to the effects of addiction, but will increase the societal costs of addiction as well as the cost to the taxpayers of North Dakota. As insurance carriers will not be required to provide various coverage and patients will not be able to afford treatment on their own. Those additional costs will be incurred through state treatment programs subsidized by the taxpayer. Therefore, not only will the taxpayer in many cases subsidize the premiums for insurance policies from the healthcare exchanges, it will also end up subsidizing the cost of treatment in one of the states treatment programs.

All Americans should have access to affordable healthcare. However, the cuts being made to mental health and addiction coverage by BCBSND as a result of the ACA is a step backward for many people, and only a small step up for the rest. As consumers and tax payers, we deserve more. After all, having insurance coverage isn’t the same as having access to medical care please don’t give us one without the other.