President-Elect Donald Trump has prompted anxiety amongst abortion providers, immigrants, and trans Americans. Thanks to recent interviews, he is also now sending ripples throughout California's sober community.
Trump wants to repeal most of the Obamacare, the nickname for the Affordable Care Act (ACA). The 2,700-page law requires all Americans to sign up for health insurance or face a tax penalty, along with many regulatory rules and programs including a government-ran health care marketplace and subsidies for low- and middle-income Americans to buy insurance. Trump has remained vague about his plans, but promised to repeal and replace the ACA, while keeping the law's two popular parts: the requirement for insurers to accept patients with pre-existing conditions, and the ability for children to stay on their parent's insurance till age 26. Trump, though, also wants to repeal the ACA proponents that pay for these requirements.
His promise to, at minimum, change the law has prompted anxiety in the sobriety community. "If sober addicts lose access to their doctors and therapists that, in part, create the support structure critical to their recovery—yes, they are more likely to relapse," says Patrick Nagle, the CEO of Rehab.com, a website that helps addicts from treatment facilities. Different approaches exist to combat addiction. Some addicts go to inpatient rehab, others attend outpatient. The National Institute on Drug Abuse recommends long term therapy and care.
Alexis Haines is a former reality star, sober opioid addict, and mother of two. She has relied on insurance bought through the ACA's programs to afford counseling. "I am covered to see a therapist who I have been seeing twice a month to reduce my risk of having postpartum depression and as a means of recovery maintenance," she says.
She has seen the negative effects of addicts living without insurance. "I [know] two mothers this year who chose not to get insurance and both of their children were ready to get help this last year," Haines says. "Their family members weren't able to afford sending them to treatment. One of them ended up getting sentenced to treatment after a felony change and found a center that would take them on a scholarship [for rehab]... the other got on an eight week wait list at a county funded facility. By the time her family got the call she no longer wanted help." If Haines lost her insurance because Trump and the Republican-controlled Senate and House repealed the ACA, she says she would pay for therapy out of pocket until she could no longer afford treatment.
Haines' husband, Evan, would also see dire consequences. He started an addiction treatment company, Alo House Recovery Centers, around the time the ACA passed. Hisbusiness has run thanks to the law opening up young people's access to insurances that could cover drug rehabilitation. "What is especially crucial to our business is the Parity Act of 2008," he explains. "Although it had already existed, before Obamacare came into law [in 2010], the Parity Act was not being enforced. The Parity Act states that mental health and substance use disorders have to be covered in the same way that any medical problem would be covered."
Nearly every day in 2014, the National Institute of Drug Abuse estimates nearly five young person died a day of a prescription drug overdose. Most died from opiod overdoses. The ACA has allowed many young addicts to gain insurance through their parents, if they are 26 or under, or through the marketplace. "Considering that probably 99.9 percent of our clients either have a pre-existing condition, or are under the age of 26, I'd say that Obamacare is crucial to helping these people," Evan says. " I don't even know what they'd do without it." According to US Department of Health and Human Services, the uninsured rate of people under 26 has dropped by 46 percent since 2013.
The ACA, though, hasn't been a fix-all for America's drug problem. The Palm Beach Post has reported that Florida rehab facilities and sober homes started cashing in by testing patients for drugs up to five days a week, because the law allowed them too. They then allegedly billed insurance companies. "Nobody ever dreamed of trying to bill an insurance company for urine," John Lehman, executive director of the Florida Association of Recovery Residences, told the Post. "That had been the status quo for many decades." The debacle led Cigna Inc, a leading health insurance company, to pull out of the ACA's Florida marketplace exchange, leaving an estimated 30,000 Floridians without insurance.
Nagle has seen other issues."Obamacare was never fully adopted. It's too soon to make a complete evaluation, and thus impossible to state that the Affordable Care Act either helped or failed addicts," he says. "One of the most significant unintended consequences of the institution of the ACA was a shift on the part of insurance companies to sending patients to intensive outpatient facilities rather than inpatient ones. It's cheaper for insurance companies to send people to outpatient programs, but this is not always the best choice for individual patients. Some are far better served in intensive 30, 60, or 90-plus day inpatient rehab programs."
Evan, however, has seen benefits of outpatient for younger women and men. "We see young people all the time, in their early 20s, who—no exaggeration—have been to inpatient treatment 15 to 20 times," he says. "More residential treatment isn't necessarily what they need." He has advocated for some younger addicts to take the outpatient approach, but also notes that different addicts require different tools for their recovery.
The sober community is aware of Obamacare's flaws, but are concerned more issues would emerge if Trump destroys the ACA. As Evan says, "Putting aside all the other concerns around a Trump presidency, to me, the prospect of losing the Affordable Care Act terrifies me, frankly."