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Originally published April 23, 2014 at 5:13 PM | Page modified April 24, 2014 at 9:13 AM

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Obamacare’s drug problem

Poor planning and unintended consequences of federal rules have created a “tsunami” wiping out local drug- and alcohol-treatment providers, Jonathan Martin writes.


Times editorial columnist

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So, it's not the ACA at all. It's a state problem. What a ridiculous headline. But it sure supplies red meat to the... MORE
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The Affordable Care Act was supposed to stir a revolution in chemical-dependency treatment. Insurance parity rules simply require illnesses of the mind to get equal coverage with illnesses of the body.

But four months into the revolution, Obamacare has a drug problem.

Poor planning and wrongheaded federal rules have put Washington’s nationally lauded chemical-dependency treatment community in critical condition, and it is fading fast.

Just this month, a 41-year-old inpatient treatment center in Madrona and a detoxification facility in Everett are closing. Other facilities are teetering on the brink, downsizing, merging or shedding jobs to stay above water. Recovery Centers of King County is losing $20,000 a month on outpatient care.

It’s gotten so bad, so quickly, that state regulators are scrambling to ensure some smaller rural counties don’t lose their sole treatment facility. I’ve heard it described as the state’s most serious crisis in chemical-dependency treatment in a generation.

The reasons for this sudden crisis are complex, and the consequences serious.

Unlike manufactured controversies of the Affordable Care Act — remember death panels?— and the technical fiasco of healthcare.gov, the treatment crisis was foreseeable. And foreseen.

At the federal level, the ACA brings with it a misguided rule limiting Medicaid funding to facilities with 16 beds or fewer.

The rule, known as the Institutions for Mental Disease (IMD) exclusion, is a de-institutionalization-era incentive to empty psychiatric hospitals. Today, it has a swarm of unintended consequences, forcing large treatment facilities around the Puget Sound to close wards (to get down to 16 beds).

Before health-care reform, the IMD exclusion was less important because not a lot of people with serious addiction were on Medicaid. The state mostly used other money to pay for treatment.

Now, most of these people are eligible for Medicaid, so it is the mother’s milk of funding. Washington’s success enrolling people on Medicaid — more than 403,000 since October — has consequences.

The surging Medicaid rolls are a problem for chemical-dependency treatment because Washington chose not to up its very low Medicaid rates as the ACA rolled out.

Treatment providers clamored for relief from the Department of Social and Health Services and the Legislature. Unbelievably, I hardly heard a peep about this in the three-month legislative session, let alone a proposed fix.

On Wednesday, Genesis House, a 48-bed treatment provider in the Madrona neighborhood, is closing after 41 years, unable to limp along on a daily rate of $53.52 per patient for inpatient care. It recently hosted a reunion of past graduates; more than 100 showed up.

“They’re sober, living these full lives, productive lives, working at QFC, at garages, taxpayers, married, living on their own,” said executive director Monica Ramsey. “I can’t tell you how heartbreaking it was,” she added, knowing closure is looming.

Now that the damage is known — and facilities are closing — the finger-pointing begins. DSHS points to the Legislature, for not upping Medicaid rates. Lawmakers say DSHS didn’t make clear the seriousness of the issue. Instead, the agency agreed to a study of the Medicaid rates that isn’t due until later this year.

“And we’re going to have more facilities going out of business while they study it,” sighed Pat Knox, executive director of Recovery Centers of King County.

When I asked Ken Stark, who ran DSHS’ chemical dependency treatment system for nearly two decades, what happened, he gave the best summary: “It really should’ve been looked at a year ago. And should have been something that went from (DSHS) to the governor to the Legislature. And it didn’t,” said Stark, who is now the Snohomish County’s human-services director.

This is a collective failure. DSHS and Gov. Jay Inslee’s administration focused on fixing problems in the mental-health system, and put this one on the back burner. But legislators also apparently chose to put ear plugs in when people like Linda Grant pleaded for relief.

Grant, with four decades in local drug- and alcohol-treatment work, is closing the Everett detoxification site of Evergreen Manor next week. It offers medical supervision as addicts are weaned off drugs to make sure they don’t have heart attacks.

When she looks around the facility, “It looks like high school.” Prescription painkillers and heroin are surging, and hook the young. “They look like babies,” Grant said about her patients.

Where will they go now when they are trying to kick their habit? Grant’s guess: to emergency rooms, at quadruple the rate she asked for just a few months ago.

At this point for people needing this kind of help, the promised revolution of the ACA looks like a step backward.

Jonathan Martin's column appears regularly on editorial pages of The Times. His email address is jmartin@seattletimes.com



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