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Fourteen million adult Americans are dependent on alcohol, yet only two to three million receive treatment each year. According to a study by Ensuring Solutions to Alcohol Problems, a new research unit of the George Washington University Medical Center funded by The Pew Charitable Trusts, even with health insurance, Americans face enormous hurdles getting treated for alcohol problems.
For most, the level of care they can get depends not on what they need, but on where they live and work. The study also reveals that a full quarter of the health plans analyzed fail to meet their state’s minimum alcohol treatment coverage requirements.
Untreated alcohol problems lead to death, disability, and $184.6 billion each year in avoidable health care, business, and criminal justice costs. Alcohol-related problems cost each man, woman and child in the U.S. $683 each year.
“The math is simple: The cost of untreated alcohol problems is colossal, while the cost of providing coverage for treatment—only pennies a month—is miniscule,” states Dr. Eric Goplerud, Director of Ensuring Solutions.
“Employers are looking for the greatest value in their health care purchasing and see treating alcohol problems as an important way to achieve that,” said Andrea Floyd, Senior Vice President, National Business Coalition on Health.
“Workplace Solutions: Treating Alcohol Problems Through Employment-Based Health Insurance” examines how employment-based insurance benefits cover alcohol treatment services. For the report, national experts on alcoholism treatment developed recommendations for treating four hypothetical people from different backgrounds with various alcohol problems. The recommendations were then compared with the treatment benefits of self-insured (or ERISA) health plans (which are exempt from state laws) and plans that must conform to state laws. Less than a third of the health plans offer benefits that cover all or nearly all of the services needed by the hypothetical people. Thirty-two health plans covering the largest number of workers and their families in a sample of 25 states and 16 plans offered by large self-insured employers were reviewed for the study.
The report’s findings include:
- The level or type of alcohol treatment that is covered by your insurance depends on where you live. Only 7 states have so-called parity laws that require health insurance companies to sell plans that cover alcohol treatment at the same levels as other physical illnesses. Six states have no requirements regarding alcohol treatment benefits. Twenty states require that health insurance include some minimum benefit (mandated minimum), while another 17 require that at least one plan offered by insurance companies have a minimum benefit (mandated offering).
- A full quarter of the health plans that fall under state insurance mandates fail to meet their state’s minimum coverage requirements. In eight of the plans studied, the number of outpatient visits covered was just one-quarter the number that the state requires.
- Health plans shortchange alcohol treatment benefits. Many health plans charge higher co-payments for alcohol treatment than they do for the treatment of other illnesses, particularly in states with no laws or nominal requirements. And, 25% of the plans studied set maximum dollar amounts that they will pay for alcohol treatment, much lower than the limits set for mental or other illnesses.
- Workers at large, self-insuring companies face huge gaps in coverage. One-half of the 177 million Americans who are covered by employment-based insurance work for companies who “self-insure” or administer their own health plans. The study concludes that these plans do not cover critical components of alcohol treatment. The gaps can be as great as in states without laws.
About Ensuring Solutions to Alcohol Problems
Ensuring Solutions to Alcohol Problems (Ensuring Solutions) at the George Washington University Medical Center seeks to increase access to treatment for individuals with alcohol problems. Working with policymakers, employers and concerned citizens, Ensuring Solutions will provide research-based information and tools to help curb the avoidable health care and other costs associated with alcohol use and improve access to treatment for Americans who need it. The project is supported by a grant from The Pew Charitable Trusts.Previous Features
