The Impact of the Affordable Care Act on Drug Trafficking
Colin Ross[*]
Forget the Tea Party—it’s international drug traffickers who truly fear the successful implementation of the Affordable Care Act. The law of supply and demand makes it clear why. Traffickers service, and help create, the American demand for illegal drugs such as cocaine, heroin, and methamphetamine. In 2010, about 1 million Americans suffered from cocaine dependence or abuse; about 350,000 suffered similarly from heroin.[2] Those customers send a steady stream of cash that keeps traffickers well-armed, equipped, and funded. We see the devastating effects of that cash flow when traffickers fight their rivals in bloody battles on Mexican streets or brazenly assassinate top prosecutors in Honduras.[3]
No one could fault the United States for lacking enthusiasm in combatting the international drug trade. But that enthusiasm is usually directed at drug supply—arrests, interdictions, seizures, Miami Vice. Squeezing supply can keep demand in check by making drugs far more expensive and far less accessible than they would be in a legal market—and it has.[4] But the remaining demand is large enough to keep the traffickers prosperous. But were this persistent customer base to begin to erode, traffickers would be in trouble.
Meanwhile, in the hallowed halls of the United States Congress, the Affordable Care Act (ACA) enters the picture. If you didn’t know that the Act deals directly with the nation’s drug problem, join the club. The relevant parts of the law have garnered hardly a mention in most media outlets; they do not have the drama of a drug bust or a shoot-out.
But deal with our drug problem the law does, by targeting what we have too often neglected: drug demand. The fundamental idea is simple: drug abuse and addiction are deeply unhealthy and often self-destructive afflictions; the more people who have health insurance and can afford regular, and preventative, medical care, the more people who will be able to keep addiction out of their lives.[5] Because healthcare is more than resetting your broken leg or being told to go for a jog. Treatment for mental problems and substance abuse (the two are often closely related) is crucial.[6]
The ACA recognizes this by classifying mental and substance coverage as essential benefits that most new health policies must include.[7] And the substance and mental coverage must be comparable to the more standard medical and surgical coverage—this is referred to as the law’s “parity” provision.[8] Americans with health problems that often stem from or lead to the heavy use of illegal drugs will be better able to get the help they need and cease being customers of the traffickers. As far-reaching as the change may be, it is hardly radical. Parity was first put on the books in a 2008 law,[9] but because substance and mental coverage itself was not mandated, the impact was limited.
As you’ve probably heard, and possibly benefited from, the law also allows young adults to remain on their parents’ insurance plans until they are 26. This gives them healthcare in the critical years when virtually all addicts first turn to drugs. And the ban on excluding people with pre-existing conditions?[10] Being formerly addicted to cocaine is one heckuva pre-existing condition. But if we are to significantly reduce drug demand by treating addiction and preventing relapses, it is people with that type of condition that we most need to bring into the healthcare fold.
The law casts an even wider net in search of preventable and treatable addictions with its screening, intervention, and treatment referral program, known as SBIRT.[11] As with much of the rest of the law, the idea of SBIRT is to invest in a modest amount of preventative care to avoid serious health problems down the line. Screeners at sites such as health clinics and emergency rooms will automatically evaluate patients’ alcohol and drug use. They can then offer advice and information if they detect signs of substance abuse, or grant treatment referrals in severe cases.
Some have criticized the new provisions, especially parity, on the grounds that they will increase costs.[12] In the short-term, these critics are probably right. Better insurance costs more.
But we all are already paying under the status quo, in both economic and moral costs—for the addiction of our fellow citizens, for the wasted potential, for the resulting crime, and for the violence in drug source and transit countries. To not act is to accept those costs.
But the Act is on the ropes now, threatening to collapse under the weight of technical problems and misleading presidential rhetoric. Will it? The traffickers can only hope.
[*] J.D. Candidate, Harvard Law School, 2016.
[2] Substance Abuse and Mental Health Servs. Admin., U.S. Dep’t of Health and Human Servs., Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings 71 (2011).
[3] See Patrick Corcoran, ‘30 Killed’ in Gunfight as Mexico State Heats Up, InSight Crime (Aug. 31, 2012), https://www.insightcrime.org/news/analysis/30-killed-in-gunfight-as-mexico-state-heats-up/ [https://perma.cc/8FSW-4VKQ]; Marguerite Cawley, Honduras’ Top Anti-Money Laundering Prosecutor Murdered, InSight Crime (Apr. 19, 2013), https://www.insightcrime.org/news/brief/honduras-top-anti-money-laundering-prosecutor-murdered/ [https://perma.cc/Z98T-RJVW].
[4] See Peter Cohan, Is it Time to Legalize Illicit Drugs?, Forbes (July 9, 2012), https://www.forbes.com/sites/petercohan/2012/07/09/is-it-time-to-legalize-illicit-drugs [https://perma.cc/8K3X-F7WE].
[5] See generally Keith Humphreys, The Dramatic Arrival of Health-Oriented Drug Policy, The Reality-Based Community (Mar. 11, 2013), http://www.samefacts.com/2013/03/drug-policy/the-dramatic-arrival-of-health-oriented-drug-policy/ [https://perma.cc/5PDU-6HAS].
[6] See Jun Yan, Survey Finds Substantial Overlap of Mental Illness, Substance Abuse, Psychiatric News (Aug. 3, 2012), https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.47.15.psychnews_47_15_8-a [https://perma.cc/Y982-2TQB].
[7] Kirsten Beronio, Rosa Po, Laura Skopec & Sherry Glied, Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans, U.S. Dep’t of Health and Human Servs. (Feb. 20, 2013), https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans [https://perma.cc/NH6G-X2Q9].
[8] Jeffrey A. Buck, The Looming Expansion And Transformation Of Public Substance Abuse Treatment Under The Affordable Care Act, HealthAffairs (Aug. 2011), https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2011.0480 [https://perma.cc/X5V6-32UE].
[9] Mental Health Parity and Addiction Equity Act of 2008, Pub. L. No. 110-343, 122 Stat. 3765.
[10] See Jesse Singal, Why You Should Care About Obamacare, The Fix (Apr. 3, 2012), https://www.thefix.com/content/obamacare-supreme-court-addiction-treatment-decision8921 [https://perma.cc/3ZXU-32JE] (“Almost everyone who develops an addiction to alcohol or tobacco or to other drugs does so in adolescence or in young adulthood . . . .”).
[11] SBIRT: Screening, Brief Intervention, and Referral to Treatment, SAMHSA-HRSA Center for Integrated Health Solutions, U.S. Dep’t of Health and Human Servs., https://www.integration.samhsa.gov/clinical-practice/sbirt [https://perma.cc/D7JC-25WQ].
[12] See J.D. Tuccille, Mental Health Parity is a Nice Obamacare Gesture, With a Big Price Tag, Reason: Hit & Run (Nov. 13, 2013, 12:16 PM), https://reason.com/blog/2013/11/13/mental-health-parity-is-a-nice-obamacare [https://perma.cc/SZ6N-6SUW]; Merrill Matthews, New Mental Health Mandate Will Make Obamacare More Expensive, Increase Fraud And Canceled Policies, Forbes (Nov. 11, 2013), https://www.forbes.com/sites/merrillmatthews/2013/11/11/new-mental-health-mandate-will-make-obamacare-more-expensive-increase-fraud-and-canceled-policies/ [https://perma.cc/DNG2-DVH8].