Nevada’s Health Care Problem We’re Not Talking About

Skip the political blathering about “repeal and replace” the Affordable Care Act.  The law has enabled 16.4 million Americans to get health insurance as of March 2015. [OFacts]  This means there’s been a 35% reduction in the number of people in this country who are without health care insurance. [OFacts] So, instead of posturing and polarizing, let’s talk about improving the health care to which more people now have access.

NV Substance AbuseOne area in which we could be doing better is in addressing and treating addiction issues faced by citizens of Nevada. Notice the information from SAMHSA indicates most individuals who are in treatment programs are getting help with both alcohol and drug abuse problems.   However, the next two charts aren’t quite so positive.

NV Substance Abuse Treatment You read that correctly… over 85% did NOT receive treatment for substance abuse issues.

NV Alcohol Treatment PercentageYes, you read this one correctly too. Some 95.4% of individuals with alcohol addiction problems did NOT receive treatment in the year prior to the SAMSHA survey.   These numbers should improve as the policy requirements for comprehensive, basic, health insurance take effect:

“The ACA includes substance use disorders as one of the ten elements of essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2014 must include services for substance use disorders.” []

Nevada participates in the Medicaid Expansion provisions of the Affordable Care Act, and so we should expect some improvements in the percentage of individuals who have access to health insurance which covers addiction treatment programs.  That still doesn’t fully answer the question: Why are there so many untreated cases?

As of 2013 some 61% of those without health insurance said they couldn’t afford it, or they lost coverage when they lost a job. [KaiserFnd]  The financial assistance under the terms of the ACA should help, but there may still be some gaps.  “Not all workers have access to coverage through their job. Most uninsured workers are self-employed or work for small firms where health benefits are less likely to be offered. Low-wage workers who are offered coverage often cannot afford their share of the premiums, especially for family coverage.” [KaiserFnd]  So, who is most likely to be without health insurance?

    • “Individuals below poverty are at the highest risk of being uninsured, and this group accounted for 27% of all the uninsured in 2013 (the poverty level for a family of three was $19,530 in 2013). In total, almost nine in ten of the uninsured are in low- or moderate-income families, meaning they are below 400% of poverty.”
    • “While a plurality (46%) of the uninsured are White, non-Hispanic, people of color are at higher risk of being uninsured than White non-Hispanics. People of color make up 40% of the population but account for over half of the total uninsured population. The disparity in insurance coverage is especially high for Hispanics, who account for 19% of the total population but more than 30% of the uninsured population. Hispanics and non-Hispanic Blacks have significantly higher uninsured rates (25.6% and 17.3%, respectively) than Whites (11.7%).” [KaiserFnd]

And herein we run directly into the revolving door of addiction treatment access issues.

Those who may need access to treatment programs for addiction problems may (1) fall into the gap between the insured and the uninsured; because (2) of job loss or low wages; and (3) they may be spending funds on their addiction that would otherwise be available for treatment.

Enter the Boo Birds: “If these people would just stop spending money on booze and dope and start saving for addiction treatment programs… problem solved.”   How righteous? The problem is that we are speaking about ADDICTION.  We’re not talking about “discretionary” spending here in the classical sense.  And, the individuals who fall into the uninsured category are more likely low income or unemployed in the first place.

“Alcohol treatment costs vary widely depending on your individual treatment needs, your insurance, and the facility. Here are some tips to help you pay for treatment:

  • Check your insurance. If you have health insurance, call the number on the back of your card to ask about your mental health and substance abuse coverage. Find out what your out-of-pocket costs will be, including deductible and co-payment amounts.
  • Look into programs that offer sliding scale or reduced payment options. Check with your state’s substance abuse agency or call SAMHSA’s helpline (1-800-662-HELP) to ask about affordable treatment in your area.” [HelpGuide]

Checking your insurance is good advice – IF a person has insurance, “finding out the deductible/co-pay expenses is good advice as well – IF a person is in a financial position to pay those costs.  Yet again, we run into a situation in which if a person is “well off” financially, or has family resources which can absorb the costs, treatment is available.  Not “well off,” don’t have family resources to offset the costs?   Not. So. Much.

To drive this point closer to home, Nevada has 62 drug treatment center listings, 38 of which are shown as offering “payment assistance.” [DRHQ]  Making the point even more sharply – Nevada has 11 behavioral health professionals for every 1,000 people in the state, the lowest in the nation. Vermont has about 70 per 1,000; Connecticut about 60; Maine about 55. Nevada is sitting down at the bottom with Georgia, Texas, and Indiana. [PCT]

There are some efforts we could make before the next legislative season to address these issues:

  1. Research and publish the findings on the availability of alcohol and substance abuse treatment centers which provide payment assistance for low or middle income patients, and the uninsured. 
  2. Research and publish the findings on the availability of alcohol and substance abuse professional services in both our urban and rural regions.
  3. Research and publish the findings on the average waiting time for those who are seeking treatment, especially in residential treatment programs.
  4. Research and report the efforts made to attract more individuals and institutions into the field of behavioral health, including substance abuse professionals.
  5. Recommend ways the state might improve its ration of expenditures on prevention and treatment or incarceration.

It would seem logical to approach this health care issue from a positive perspective – now that the ACA makes health insurance more affordable for more people, how can we help Nevadans take advantage of treatment programs?  Further, how can we assist those who have fallen into the non-insured gap get the treatment they want and need?  How can we get Nevada off the bottom in the list of availability of behavioral health care professionals?

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