There are two kinds of drug-related madness going on simultaneously in the U.S. One is the burgeoning national problem of heroin use. The second is the insistence of some elected officials that we can't afford to pay for addiction treatment while booming heroin use siphons healthcare dollars and overwhelms prisons.
On Monday, Illinois Gov. Bruce Rauner vetoed legislation passed nearly unanimously by the Legislature that would have required the state Medicaid program to cover all forms of medication-assisted treatment for opioid and alcohol addiction. In his veto message, Rauner, a first-term Republican who's locked in a budget battle with the Democrats in control of the Legislature, said “without adequate funding to support mandated coverage for all forms of treatment, regardless of cost, this change would add to the State's deficit.”
Meanwhile, in Maine, a not-for-profit outpatient drug treatment center soon will become the second clinic in that state to close this year despite an ongoing heroin epidemic there. The treatment center's CEO blamed Maine's Republican governor, Paul LePage, who has vetoed legislation to expand Medicaid that could have helped fund treatment for lower-income Mainers with addiction problems. LePage's administration also has tightened Medicaid eligibility requirements and cut payments to providers.
“Gov. LePage is discussing calling in the National Guard to combat the state's drug epidemic while leaving multimillion-dollar grant opportunities for funding treatment on the table,” said Charles Faris, CEO of Spectrum Health Systems.
In Illinois, the Rauner administration had estimated the bill's annual cost for Medicaid coverage of addiction treatment at $15.4 million. The bill's chief sponsor, Rep. Lou Lang, a Democrat, said “there is a whole swath of people out there who need healthcare from the state who have drug addictions. The governor is taking the position that we can't afford to save these lives.”
A recent report from Roosevelt University researchers found that from 2007-2012, state funding for addiction treatment in Illinois dropped by nearly 30%, causing the state to fall from 28th in the nation to the third worst state in terms of providing publicly funded treatment.
At the same time, the state's heroin problem has grown, with 633 overdose deaths in 2014, up from 583 the year before. The Chicago metro area has experienced more hospital emergency department visits linked to heroin than any other major U.S. city, with 24,637 cases in 2011, the latest year for which data were available.
In the Chicago area, Cook County Sheriff Tom Dart has pushed hard to expand community-based treatment programs for people with substance abuse and mental health problems as an alternative to incarceration.
But in a recent Modern Healthcare interview, Dart said, “We are not optimistic about governments providing the funding levels these programs need throughout the state.”
David Cohen, a former heroin addict who now is vice president of substance abuse treatment at Insight Behavioral Health in Chicago, said outpatient addiction treatment centers in Illinois are cutting hours and staff because of the state's budget squeeze. “I get that some things have to be cut,” he told the Daily Herald.
“But I don't see it as a win-win cutting treatment. You're going to have more crime, more people incarcerated, more people in emergency rooms. It's going to cost the state anyway.”