There are an estimated 408,000 Tennesseans — approximately 8.3 percent of the population — who need treatment for substance abuse.
Slightly more than 10 percent of that number — an estimated 47,000 — are currently receiving treatment in one the state’s various intensive outpatient, individual and inpatient programs.
When the Affordable Care Act goes into effect on Jan. 1, an additional 57,918 Tennesseans with substance abuse problems will be eligible for health insurance. While it is a drop in the bucket compared to what is needed, these newly insured drug addicts are sure to tap an already over-burdened system.
In the 60 years since the medical profession recognized addiction as a treatable disease, there is still a huge gap between need and access to care.
It is estimated that only one cent of every health care dollar in the United States goes toward addiction and few alcoholics and drug addicts receive treatment.
It is estimated that 180,000 Tennesseans will be eligible for coverage through the health insurance exchanges beginning on Jan. 1, 2014.
One of the tenets of the ACA is that mental health and substance abuse treatment are part of essential services that are identified, said Andy Black, chief executive officer of Helen Ross McNabb, which provides mental health, substance abuse and social services to more than 21,000 adults and children each year.
Black said while the mental health system “is in pretty good shape,” for people with substance abuse problems, “the system is woefully inadequate. It’s always been woefully inadequate.”
So how will the already strapped agencies help the thousands of new patients who will come through the doors with their new insurance cards in hand?
“I think we’ll be able to hire up to meet the needs of the patients,” Black said.
Randy Jessee, senior vice president of special services for Frontier Health, which serves 50,000 patients per year in eight East Tennessee counties — including Hancock, Hawkins and Greene counties — and four counties in Southwest Virginia, said his agency is reimbursed by a federal block grant for the treatment of uninsured patients.
“There is a waiting list for services,” he said. Patients have to meet certain criteria to determine if they’ll be put on the waiting list or if they qualify for immediate treatment. He said that, for example, a IV-using, drug-addicted pregnant woman would get priority treatment.
“We really don’t know how that’s (the ACA) going to shake out,” Jessee said. “We know what services we have available now.”
The problem, he explained, is that just because patients now have access to care, it doesn’t mean the infrastructure is in place to provide care.
“There are limitations in how you deliver care,” Jessee said.
One of the services Frontier Health provides is medically monitored detox, which requires nurses and doctors available around the clock.
He explained that any treatment requiring 24/7 care is going to cost more.
The limiting factor, in addition to staff, is the number of available patient beds.
Frontier currently only has 12 female and 11 male beds.
“If we get 10 percent more people applying for care, I’m in trouble,” he said. “I don’t have the capacity to deal with it.”
Jessee said that an increase of only 15 to 20 percent would require Frontier to assess the financial costs to provide services for additional people. He estimated it could cost $1 million in operating costs alone for each additional 15 beds.
“It could be a lot higher than that,” he said.
The problem, according to Treatment Research Institute CEO Tom McLellan, who was President Barack Obama’s former deputy drug czar, is that the system in place for the treatment of drug abuse was built at a time when the medical community didn’t understand addiction was an illness.
The system is already full to overflowing in many places. In more than two-thirds of the states, treatment clinics are already at or approaching 100 percent capacity.
“As the health insurance exchange progresses, we’re going to be responsive to it and participate and literally thousand of people will have additional opportunities to access care,” Black said.
While Tennessee has opted not to increase Medicaid enrollment, Jessee said the Volunteer State is one of the lucky ones. Gov. Bill Haslam and the mental health commissioner have increased resources into the area.
“It’s still painfully inadequate,” he said.