healthcarejournalbr.com | July / August 2008 Issue |
Healthcare Journal of Baton Rouge
65
Specific examples include these nationwide statistics.
Studies show that 12.3 million adults currently use illicit
drugs, and 9.4 million of them (77%) are employed.
1
According to the Substance Abuse and Mental Health
Association, no occupation is protected from substance
abuse. The highest rates of current illicit drug and alcohol
use were reported by food workers, waiters, and bartenders
(19%); construction workers (14%); and transportation and
material moving workers (10%).
2
Small businesses are the employer of choice for the alco-
holic or addicted person seeking employment. According to
the U.S. Department of Health and Human Services, among
the population of full-time employed current illicit drug users:
44% work for small establishments (defined as having 1-24
employees), 43% work for medium businesses (25-499
employees), 13% work for large businesses (500 or more
employees). Among the population of full-time employed
heavy drinkers, 36% work for small businesses, 47% for
medium size businesses, and 17% for large businesses.
3
A
reason that small businesses may be particularly affected is
that many do not have drug-free workplace policies such as
random or pre-employment drug screening.
Most small businesses do not have substance abuse cover-
age in their health insurance policies. I am told that this is
because so few businesses have the policy, that if a small
business owner requests the benefit, it is presumed that an
impaired employee is a member of the group and the policy
premiums are more expensive.
A solution to this is if all businesses had health insurance
which provided treatment for substance abuse. The business
community is concerned that this will be as expensive as it is
when only one business provides the coverage. Fortunately,
this is not the case. In fact, improving substance abuse treat-
ment can actually save money.
First, providing substance abuse treatment coverage is
affordable. In a study done in 2001, the privately insured on
average spent less than $6 annually, for substance abuse.
4
It
is estimated that if a $10,000 limit on substance abuse cov-
erage was removed and employers offered treatment for
substance abuse, the estimated cost would be 6 cents/work-
er per year.
5
Second, when substance abuse treatment coverage is
expanded and studies are done to compare use and
expense before and after coverage, there is minimal or no
increase in expense. For example, when the federal govern-
ment expanded coverage of substance abuse, there was no
net increase in spending for this treatment for federal
employees across the United States.
6
Similarly, another eval-
uation of a state parity law found a reduction in use of sub-
stance abuse services after parity.
7
Third, effective treatment of substance abuse can decrease
the amount spent on other health costs. As a physician, I see
firsthand the effects of untreated substance abuse and drug
addiction. For the last 20 years, I regularly dealt with patients
who damaged their overall health or particular parts such as
their liver or other organs as a result of alcohol and drug
abuse. Less apparent, but real is the associated spousal and
child abuse in the homes of a parent with a substance abuse
problem. And in 2007, a total of 978 people in Louisiana were
killed in traffic crashes, 49% of which were alcohol-
related–far above the national average of 41%.
8
To address these problems, Senator Ben Nevers, himself a
small business owner, and I co-authored legislation that
would provide coverage to treat substance abuse and men-
tal illness in insurance policies. This legislation provided for
this important coverage and included a number of measures
to address the concerns of businesses and industries about
the cost of such coverage. The most important is that there
would be a tax credit given to offset any increased premium
costs that may result. This bill balanced providing coverage
for employees and not increasing costs to businesses.
It would be good for businesses, good for employees and
good for Louisiana.
v
1
U.S. Department of Health and Human Services Substance Abuse and Mental
Health Services Administration. (2000). 1999 National Household Survey on Drug
Abuse. Rockville, MD: U.S. Department of Health and Human Services.
2
U.S. Department of Health and Human Services Substance Abuse and Mental
Health Services Administration. (1999). Worker Drug Use and Workplace Policies
and Programs: Results from the 1994 and 1997 NHSDA. Rockville,
MD: U.S. Department of Health and Human Services.
3
Ibid.
4
Mark and Coffey, “The Decline in Receipt of Substance Abuse Treatment.”
5
R. Sturm, W. Zhang, and M. Schoenbaum, “How Expensive Are Unlimited
Substance Abuse Benefits under Managed Care?”
Journal of Behavioral Health
Services and Research
26, no. 2 (1999): 203-210.
6
HH Goldman, RG Frank, MA Burnam, et al. Behavioral Health Insurance Parity
for Federal Employees.
New England Journal of Medicine
354: 1378-1386.
7
M. Rosenbach et al., “Effects of the Vermont Mental Health and Substance Abuse
Parity Law,” Pub. no. SMA-03-3822 (Rockville, Md.: SAMHSA, 2003).
8
LSU's LA Highway Safety Research Group, 2007 Traffic Crash Report.
1957:
Though seldom used, 27 states (not
Louisiana) still have sterilization laws on the
books.
1959:
Psychiatry becomes a field requiring
medical training.