Recorded presentation

Eric Goplerud, PhD and Delia Olufokunbi, PhD. Center for Health Service Research & Policy, George Washington University Medical Center, 2021 K Street, NW, Suite 800, Washington, DC 20006, 202-530-2302, goplerud@gwu.edu

The federal government estimates that 7.4% of full-time workers have a diagnosable alcohol problem. Most of them rely on employer-based insurance plans for their health care but a study of 48 health plans in 25 states indicates that the extent of insurance coverage for alcohol treatment under these plans varies widely and often is inadequate.

A panel of addiction experts developed alcohol treatment plans for an adult male, an adult female, a pregnant female and an adolescent male. Researchers then compared these recommendations to insurance coverage provided by employers under 48 different health plans. These comprised 1) 32 health plans falling into one of four categories of state insurance regulation; and 2) health plans offered by 16 large self-insured employers, who are exempt from state regulations under federal law.

The study found that fewer than one third of the health plans provided coverage for all of the recommendations. Under most of the remaining plans, the individuals would receive less than half of the recommended outpatient counseling; they would not have access to family therapy and case management; and they would be required to pay more out of their own pockets for alcohol treatment than for other medical conditions.

This treatment gap existed in both state-regulated plans and self-insured plans. The study concludes that the Americans with alcohol problems are much more likely to get the services they need in states where insurance laws require that treatment for alcohol and other drug problems be equal to that provided for other medical conditions.

Learning Objectives: At the conclusion of the session, the participants will be able to

• describe how four categories of state insurance regulation affect coverage of treatment for alcohol problems in employer based health insurance plans;
• recognize how employers can discriminate against workers with alcohol problems in self-insured health plans; and
• better articulate why laws mandating parity for addiction treatment are needed to close pervasive gaps in employer-based health insurance coverage.

Keywords: Treatment System,

Related Web page: www.ensuringsolutions.org/pages/rerere.html

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation