Saturday, February 15, 2014

Wyoming spends unnecessarily on substance abuse treatment

“Did you know 15 minutes could save you 15% or more on car insurance?”

“Everybody knows that!”

“Yes, but did you know Wyoming needlessly spends ninety-eight-million, seven-hundred-twenty-three-thousand dollars ($98,723,000) each biennium for substance abuse and mental health treatment.”

That sounds odd coming from one who spent a decade working to increase that budget. In 2000, Dr. Dennis Embry, State Representative Doug Osborn (R-Buffalo), and I authored the most comprehensive substance abuse treatment and prevention plan in America. The legislature funded it with a 25 million dollar appropriation. Most of that went to treatment.

Soon after that a select committee persuaded the legislature to add tens-of-millions more to the treatment budget. That was necessary then; not anymore.

What changed? An understanding of the historic development of community mental health and substance abuse centers is helpful. These programs began in the 60s under President Kennedy. Community mental health centers opened largely with federal grants and community funds. The state government contributed very little.

Over time, as the need for treatment grew and federal funds were insufficient, the mental health centers turned to state legislators to augment funding. The state once funded 10% of their budget. That increased substantially during the meth scare of the 90’s and early 2000s. Today the state funds most of their budgets.

Since then, there were two developments legislators should recognize have eliminated the need to appropriate 98.7 million for mental health and/or substance abuse treatment.

First, those massive appropriations preceded Senators Mike Enzi’s and Ted Kennedy’s success in pushing through Congress the Mental Health Parity Act of 2007. Before then, nearly everyone needing treatment was either uninsured or underinsured because most health insurance policies didn’t cover treatment.

The Enzi-Kennedy law changed that, requiring group health insurance plans offering mental health coverage to provide mental health benefits no more restrictive than the policy provisions pertaining to medical/surgical benefits. The law achieved parity in group insurance policies for all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums.

The second development was Obamacare or the Affordable Care Act (ACA). Today every policy, group or individual, as well as Medicaid, must fully cover these treatment services. Those requirements are coupled with the mandate to purchase insurance meaning that anyone without health insurance has made that choice. There’s one exception and that is the 17,000 Wyoming citizens who cannot afford insurance and make too little to receive premium subsidies. These are the folks the ACA was designed to cover through Medicaid expansion.

So, unlike earlier years when people who needed treatment were unable to afford it and the state had to pick up the tab, today everyone is either insured or choosing not to be insured or falling through the Medicaid expansion crack.

As a result, there is no longer any justification for Wyoming legislators to appropriate such huge sums of general funds for treatment. The Wyoming Department of Health estimates that expanding Medicaid would save taxpayers 47 million dollars over the next seven years.

Forty-seven million over seven years is nothing to sneeze at, but that pales in comparison to what could actually be saved. Someone needs to get out a hatchet and do some serious budget cutting. A hard, honest look at the mental health and substance abuse treatment budget could result in savings of at least 40 or more million dollars each year in addition to the 47 million.

Curiously, while experts know that recovery support services are vital to the success of treatment, less than 2% of those nearly 99 million dollars are currently spent on recovery support. After an 80% cut, enough would remain to adequately fund recovery services.  

Medicaid expansion would complete the continuum under which the ACA makes certain everyone in America has the opportunity to be covered by health insurance. As a result, everyone who needs mental health and/or substance abuse treatment will be able to afford it and insurance can take the place of most of those 98.7 million state taxpayer dollars.

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