Misprojecting the Impact of Expanding Insurance for Addiction Treatment

The Affordable Care Act will allow addicted people far more and better treatment options than they have today

Michael Dhar and Christie Thompson have both been doing some serious, long-form reporting on how the Affordable Care Act will affect addiction treatment. Both of them asked me a question based on what I consider a misinformed Associated Press story: What does it matter that the ACA gives millions of people insurance for addiction treatment when current services are often overwhelmed with too many patients?

The AP looked at current, underfunded services for uninsured addicted patients and observed quality and access problems. Fair enough. But AP then drew a questionable conclusion: That newly insured patients will go to these same, overwhelmed, underfunded treatment programs, thereby compounding the current shortage. That’s a bit like interviewing people in an overstretched food bank on the eve of a new government program that will give every family $200 a week to spend in restaurants and concluding that the food banks are going to be overwhelmed by the new program.

The AP analysis underappreciates the dynamic nature of the U.S. health insurance and health care systems. Health care providers want to make money. When millions of people gain insurance for some medical condition as will happen under the ACA, providers expand services to capture the business. The overstretched public sector programs for uninsured addicted patients profiled by AP might very well have fewer rather than more patients after the ACA goes into full effect. That’s because there will be more care options available for addicted people, including outside of the public sector. And as for the widespread quality problems in addiction treatment, the growth of insurance coverage is good medicine because addicted people will have more health care options than they do now, creating an incentive that currently doesn’t exist for treatment quality improvement.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

7 thoughts on “Misprojecting the Impact of Expanding Insurance for Addiction Treatment”

  1. I imagine the same would be the case for many other government programs that have been cut or underfunded into dysfunctionality. Isn’t this part of starving the beast as a strategy – to make observable services look incompetent and thus examples of the existential futility of government? Look at the terrible state of that bridge, and you want to spend *more* money on it?!!! etc.

    It’s a neat trick.

  2. If you look at the history of medical-care facilities for the elderly pre and post medicare, it’s pretty clear that increased investment follows the availability of money.

    On the other hand, if you look at the history of medical-care facilities for the elderly pre and post medicare, it seems pretty obvious that some serious investment in investigative and enforcement resources aimed at new and expanding providers would be an awfully good idea.

  3. Th stereotype “addict = penniless marginal, wino” may be at work. The idea that many addicts are middle-class or professional workers (journalists, real-life equivalents of Sherlock Holmes, Senators) holding down full-time jobs is hard to fit in.

    1. But the John Galt addicts can afford treatment! Those who can’t are no better than penniless marginal winos.

    2. Good point James. It shocks and scares people to know this, but a great counter-example to the homeless wino stereotype are physicians and nurses, both of whom in every survey study show rates of addiction equal to or slightly higher than the general population.

      1. Location, location, location.

        Has treatment for medical personnel gotten any better? (My recollection is of a study where the vastly most common sign of relapse from treatment for addiction to fentanyl was death.)

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