The End of Rehab?

The End of Rehab?


The End of Rehab or the Start of a New Chapter?

As 2014 fades into the history books and 2015 looms right around the corner, we’re poised to see some major changes occurring in healthcare.

obamacare and rehab

Since its inception in 2008, The Affordable Care Act, better known as Obamacare, has shaken up the world of medicine. From its promise to insure every American to its promise of affordable copays and deductibles, the ACA has some big shoes to fill.

So far, with the exception of the temperamental website, Obamacare has done pretty well. It got rid of preexisting conditions. It expanded Medicaid coverage. Between 2013 and 2014, it’s estimated that 3.8 million people received health insurance thanks to the ACA. Estimate or not, that’s nothing to scoff at.

Okay, the Affordable Care Act has, generally speaking, brought positive change. What about addiction medicine, though? How does that factor into President Obama’s insurance overhaul? More importantly, why are some people proclaiming the end of rehab as we know it?

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How Obamacare Already Changed Rehab

In the brief two years it’s been around, Obamacare has already brought some major changes to addiction treatment. First and foremost, it got rid of preexisting conditions. This means that insurance companies can’t deny people coverage based on any illness they already have.

Today, substance use disorders are considered one of the ten elements of “essential health benefits.” Score one for addicts and alcoholics across the country!

Next, the ACA expanded parity rules. These are the rules governing how insurance companies cover mental illness and addiction treatment. This expansion took the form of the 2008 Mental Health Parity and Addiction Equity Act.

This law evened the playing field for addicts, alcoholics, and those with mental illness. Prior to this, deductibles, copays, and annual visits to treatment centers were held to a different standard than non-addiction medicine. After the law was passed, both the financial and treatment components of addiction medicine must be equal to any type of non-addiction medicine.

According to a 2013 estimate by the U.S. Health and Human Services Department, this expansion of parity rules will increase mental health and substance abuse benefits for as many as 31 million people. That’s a lot of people!

It’s plain to see that the ACA has already brought some significant change to how addiction is treated in America, but what does the future hold for Obamacare and rehab?

How Obamacare May Change Rehab

Here’s where things start to get controversial. This is also when we leave the world of concrete facts and venture into educated guesses.

Now that substance use disorders fall into the category of essential health benefits, some sources suggest that rehabs will change how they operate. Kevin Kunz, the Vice President of the American Board of Addiction Medicine, is quoted as saying,

“We could put a ‘rehab’ center on every corner in America and it would not treat this problem…What will change it is the integration across health care of the knowledge this is an expensive in all ways, preventable and treatable illness” (from the KCRW site).

This “integration across health care” may take the form of treatment centers moving from spiritual and twelve-step modalities to a cut and dry scientific approach. It’s also thought that treatment will shift from specialty facilities to individual’s primary care doctors.

affordable care act and rehab

What’s cotton fever?

While there’s nothing wrong with incorporating science and spirituality, it’s sure to ruffle some feathers. After all, a spiritual and twelve-step approach offers some significant benefits. Consider that Alcoholics Anonymous has helped millions of men and women recover from addiction and alcoholism. Consider they boast a membership that’s upwards of two million people.

Now, what about the shift away from treatment centers in favor of primary care physicians? There’s nothing wrong with this on paper. In fact, it appears to offer some benefits. Primary care doctors know their patients, their patient’s family, and their patient’s history. They should be able to offer more insight than a doctor who knows nothing about a particular patient.

Sounds good…in theory. In practice, these general care doctors may not know enough about addiction to offer meaningful care. They haven’t been trained in addiction or mental health medicine. This could lead to things like overprescribing potentially dangerous medications (think Suboxone and the like) and misdiagnosing mental illness.

After all, what good is having access to addiction treatment if the treatment itself stinks?

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