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Search Terms: mental AND health AND parity, House or Senate or Joint

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JULY 30, 1999, FRIDAY

SECTION: IN THE NEWS

LENGTH: 2608 words

HEADLINE: PREPARED TESTIMONY OF
JENNY COLLIER-MCCOLL, J.D.
DIRECTOR OF NATIONAL POLICY
FOR THE LEGAL ACTION CENTER
BEFORE THE HOUSE COMMERCE COMMITTEE
SUBCOMMITTEE ON HEALTH AND ENVIRONMENT
SUBJECT - BARRIERS TO ALCOHOL AND DRUG TREATMENT
AND PREVENTION SERVICES

BODY:

Introduction
Good morning, Mr. Chairman, Congressman Brown, and members of the Subcommittee. My name is Jenny Collier-McColl and I am the Director of National Policy for the Legal Action Center, a non-profit law and policy firm that represents individuals in recovery from and struggling with alcohol and drug problems and AIDS and their treatment providers. Thank you for this opportunity to testify on "The Drug Addiction Treatment Act of 1999," and access to alcohol and drug treatment services.
Expanding alcohol and drug treatment and prevention services is an essential step to meeting the Congress' goals of reducing youth drug use, successfully reforming the welfare system, and decreasing crime. Last year, drug use among youth remained at the highest level in ten years. Access to alcohol and drug treatment does not meet the current need for services - only 50% of the individuals who need treatment receive it. Waiting lists for alcohol and drug treatment are six months long in some regions. For adolescents the problem is much worse -- only 20% of adolescents with severe alcohol and drug problems receive treatment. More treatment and prevention services are needed now, especially since the need for them is growing daily.
While developing appropriate new, research-based addictions medications and protocols, such as Buprenorphine, is an essential part of improving treatment effectiveness, these activities alone do not significantly expand access to alcohol and drug treatment. Inadequate private and public funding for alcohol and drug treatment services is the most significant barrier to treatment and prevention services. Congress must address this problem so that we can develop a comprehensive system of care for this nation.
Lack of funding for treatment also reduces incentives for treatment expansion by providers and medications development by pharmaceutical companies. Even if we succeed in developing the best, most effective care and medication for individuals with alcohol and drug problems, treatment providers, both public and private, as well as pharmaceutical companies will be unable to invest in them without sufficient funding to support these innovations. Therefore, in addition to supporting development and access to new treatment medications and protocols, as Congressman Bliley's "Drug Addiction Treatment Act" attempts to do, Congress must increase its financial commitment to alcohol and drug treatment in order to significantly increase access to these services.
A final barrier to treatment is stigma around the diseases of alcoholism and drug dependence. Stigma shows its ugly face in several ways, from legislatures trying to defund certain types of treatment to communities resisting the placement of alcohol and drug treatment facilities or sober housing in their neighborhoods. Increased financial investment coupled with action to destigmatize these diseases are solutions to overcoming the barriers to treatment.
Alcohol and Drug Treatment and Prevention Are Highly Effective
Providing alcohol and drug treatment and prevention services reduces drug use as well as the associated health, welfare, social, child welfare and criminal justice costs. The 1996 National Treatment Improvement Evaluation Study (NTIES), which evaluated 78 treatment programs funded by the Center for Substance Abuse Treatment (CSAT), found sustained reductions in drug use, welfare dependence, and crime and increased employment among 5,700 individuals one year after they completed treatment.
Specifically, NTIES found that:
- Crack use decreased by 50.7% and heroin use by 46.5%.
- Employment increased by 18.7% and welfare dependence decreased by 10.7%.
- Homelessness decreased by over 40%.
- Drug sales decreased by 78.2%, physical beatings by 77.6%, and shoplifting by 81.6%.
Research-based prevention programs are extremely effective in preventing alcohol and drug use among youth. The National Structured Evaluation, an evaluation of services provided in prevention programs across the nation between 1980 and 1993, found that a variety of approaches including counseling, peer leadership, stress management, skills development and other techniques effectively prevent alcohol and drug use.
Pressures on the Public Treatment and Prevention System
Treatment and prevention systems have faced increased pressure from entitlement reforms, specifically welfare and SSI program reforms, that decrease system capacity while increasing the need for public treatment and prevention services.Welfare reform has reduced treatment availability by making individuals convicted of drug felonies after August 22, 1996 ineligible for cash assistance or food stamps in many states. Residential treatment programs, particularly programs serving low-income women and children, have relied on the these funds to help support room and board costs of carWithout these funds, treatment availability will decrease.
Welfare reform also requires states to move individuals from welfare to work within a given time period, or a state's federal welfare funding will be decreased. Several national studies have concluded that 16-20% of welfare recipients have alcohol and drug problems. This could translate into an additional 400,000 - 1,000,000 adult welfare recipients needing treatment to move into recovery, off welfare, and into jobs.
This increase in the need for women's treatment, particularly women with children, comes at a time when this system faces great financial pressure. Funding from the Center for Substance Abuse Treatment, which has supported residential programs for women with children and programs for pregnant and postpartum women and infants, has ended or will be ending this fiscal year for the majority of grantees. Without additional funding, many programs for women with children will have to reduce or discontinue the services they offer, thus widening the treatment gap for these families.
Loss of Supplemental Security Income (SSI) support for individuals with alcohol and drug problems also has increased the need for public treatment services. On January 1, 1997, an estimated 200,000 individuals with alcohol and drug disabilities lost their SSI and Medicaid coverage. Less than 60,000 of these individuals have requalified for SSI and Medicaid under another disability. Methadone maintenance, residential, and outpatient programs have relied on Medicaid to provide treatment. These programs now face budget gaps which reduce treatment availability.
Successful criminal justice programs involving (and often mandating) treatment, including drug courts, have proliferated and are steadily increasing the demand for treatment. The success of these programs hinges on adequate and immediate treatment availability.

Increased Public Funding will Expand Access to Treatment
The primary source of federal funding for alcohol and drug treatment is sent directly to states through the Substance Abuse Prevention and Treatment (SAPT) Block Grant. The Substance Abuse Block Grant accounts for over 40% of public funding for these services nationwide.
To help meet the pressing need for alcohol and drug treatment and prevention services, we urge Congress to increase funding for the SAPT Block Grant to $1.885 billion for an overall increase of $300 million over FY 99 funding.
In addition to adequate funding for the Substance Abuse Block Grant, increased funding should be invested in Targeted Capacity Expansion programs under the Centers for Substance Abuse Treatment and Prevention to help meet the evolving needs of communities. These programs are targeted, gap filling services tailored to address specific and emerging drug epidemics and/or underserved populations.
Increasing Medicaid Coverage Will Expand Access to Alcohol and Drug Treatment
Many low-income individuals, including all women on welfare and those in families involved in the child welfare system, are eligible for Medicaid, the main source of health care funding for low-income individuals without private health insurance. However, Medicaid coverage for alcohol and drug treatment services for these individuals and families is unnecessarily limited.
The national goal of reducing alcohol and drug use and their devastating consequences on individuals, families, and society requires better Medicaid coverage for treatment. Medicaid coverage for alcohol and drug treatment could be enhanced by:
Making alcohol and drug treatment required services under the Medicaid program.
Medicaid finances some drug and alcohol treatment, subject to state limits on amount, duration, and scope, but alcohol and drug treatment is not a required service under the program. States providing treatment to Medicaid clients can receive reimbursement if the treatment is provided under a Medicaid service category that qualifies for Federal matching funds.
For example, if alcohol or drug detoxification is provided as part of general inpatient hospital treatment, it is reimbursable under Medicaid in most states. Other aspects of treatment, such as prescription of methadone, may also be covered. At State option, clinic treatment services can also be covered.
The advantage of this policy change is that it would help establish a more stable source of funding for treatment that is not discretionary and subject to the annual appropriations process. Such stability will increase access to treatment for low-income individuals and families who presently rely on limited Substance Abuse Prevention and Treatment Block Grant and scarce discretionary funds to support treatment services.
- Lifting the "IMD exclusion."
One of the most serious roadblocks preventing low-income individuals from obtaining residential alcohol and drug treatment has been the "Institution for Mental Diseases (IMD) exclusion." The IMD exclusion is a statutory provision that prohibits Medicaid from paying for institutional treatment for individuals between 22 and 64 who are diagnosed with mental diseases and receiving treatment in programs with more than 16 treatment beds. In addition, individuals who enter IMDs lose their Medicaid eligibility for all Medicaid reimbursable services, including prenatal and HIV care.
While Congress never explicitly defined mental diseases to include alcoholism and drug dependence, the Health Care Financing Administration (HCFA) has interpreted mental diseases to include addiction. Numerous organizations and advocates have spent years trying to change the IMD exclusion as it applies to alcohol and drug treatment, both through the courts and the legislative process.
The simplest way to change the IMD exclusion would be to amend the regulations by removing "substance abuse" from the definition of "mental diseases."
However, legislative options are also available. During the 105th Congress, Senator Daschle introduced legislation, S. 147,l which would lift the IMD exclusion for pregnant and postpanum women? The Congressional Budget Office scored a previous version of this legislation as costing only $145 million over five years.3
Substance Abuse Parity Will Expand Access to Treatment
Government has overlooked an important partner in the solution to the alcohol and drug problems - the private sector. More than 70 % of drug users in 1996 were employed, including 6.2 million full-time workers and 1.9 million pan-time workers. Unfortunately, some workers have unnecessarily limited health insurance benefits for alcohol and drug treatment, and others have none at all.
According to a 1993 study, most private health insurance plans that cover alcohol and drug treatment set annual and lifetime financial and visit limits on the benefits. These limits, combined with the fact that drug abuse is a chronic, recurrent condition, mean that covered individuals quickly exhaust their benefits.
When privately insured individuals exhaust their benefits, they turn to the public sector for treatment, which increases costs to federal, state, and local governments. A 1994 study estimated that 20 % of public reimbursements are for clients who have private health insurance. Privately insured individuals seeking treatment in the public sector crowd out individuals traditionally served by the public sector and increase waiting lists for publicly-funded treatment.
Better and more comprehensive private health insurance coverage is affordable. A 1997 actuarial study estimated that full parity would increase insurance premiums by just one-half (.5) of 1%, only pennies per day per person covered.4 A 1998 study by Mathematica Policy Research estimated that full parity for alcohol and drug treatment services would cost even less increasing composite health insurance premiums by one-fifth (.2) of 1%.5 Providing drug and alcohol treatment services on par with services for other physical illnesses will decrease health care and other costs for employers. Health care costs will decrease because treated employees and members of their families use fewer health services. Untreated alcoholics incur general health care costs that are at least 100 % higher than non-alcoholics. Sickness claims, hospitalizations, and days lost to illness drop by 50% after treatment.6 Health care utilization by the family drops 50%.7 Other costs incurred by employers from absenteeism, disability days, and disciplinary actions all decrease by more than 50% after treatment.8
Stigma Produces an Additional Barrier to Treatment
Alcoholism and drug dependence are treatable diseases that should be dealt with by the public health system. However, many individuals view these problems as moral failings as opposed to medical conditions. This mentality perpetuates the stigma that closets these diseases and prevents investment in and development of a comprehensive treatment system. Educating individuals, communities and policy makers about the treatable nature of addiction and the potential for real recovery will reduce stigma and its negative consequences. Congress plays an important role in this educational process, and I thank the members of this Subcommittee for holding this hearing about alcoholism and drug dependence and the success of treatment. Conclusion
Prevention, treatment and continued research are our best hope for reducing alcohol and drug use and their associated crime, health, welfare and social costs. Continued investment in these areas will save lives and resources nationwide. Thank you for inviting me to speak on this important issue today. I will be glad to answer any questions.
FOOTNOTES:
1 The "Medicaid Substance Abuse Treatment Act of 1997" is also co- sponsored by Senators Chafee, Kennedy, Johnson, and Reid.
2 The bill would prohibit reimbursement for facilities with more than 60 beds (unless waived by the state alcohol and drug agency) or licensed as a hospital. It would also set a ceiling on the number of beds covered at 1,080 in 1998 up to 6,000 in 2002. After 2002, the Secretary would determine the number of beds covered.
3 The provision had been included in the Senate version of the 1993 budget reconciliation act but was dropped in conference committee.
4 Milliman & Robertson, "Premium Estimates for Substance Abuse Parity Provisions for Commercial Health Insurance Products," September 2, 1997.
5 Substance Abuse and Mental Health Services Administration, "The Costs and Effects of Parity for Mental Health and Substance Abuse Insurance Benefits," prepared by Mathematica Policy Research)
6 President's Commission on Model State Drug Laws, "Socioeconomic Evaluations of Addictions Treatment," 1993.
7 Ibid.
8 Ibid.
END

LOAD-DATE: August 3, 1999

Document 67 of 103.


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