In 1989, at the dawn of our industry's battle with managed care,
Pennsylvania legislators passed a bill that contained some of the most
ironclad language guaranteeing access to quality inpatient treatment
that has ever been approved by any legislature at any time in this
country's history. Yet, throughout the 1990s, as managed care wrought
its apocalypse on inpatient treatment in Pennsylvania and throughout
the nation, the historic state law sat on the books gathering dust,
Finally, in 2003, the Pennsylvania Insurance Commission agreed with treatment providers that the law essentially meant to put inpatient treatment decisions firmly into the hands of providers, a ruling that was upheld by a state court. But the nearly 15 years in which managed care was able to hold sway in the state despite the law's passage has meant that, in essence, managed care has still won. That's because, in the intervening period, it was able to impose on the state treatment providers its outpatient model of care. Some of the state's largest providers, including Gateway Rehabilitation Center, cut back sharply on inpatient and allocated most beds to publicly funded clients, all the while building large outpatient businesses. The tale of how this happened in Pennsylvania, when it was clearly against the law, is a disturbing one for the industry. Participants in the battle say providers tried in the 1990s to get the state attorney general and insurance commission to enforce the law, but to no avail. The valiant efforts of people like Deb Beck of the Drug and Alcohol Service Providers of Pennsylvania, DASPOP, were apparently no match for the deep pocketed healthcare insurance lobby, which every year spends tens of millions of dollars in state capitals nationwide. That's no surprise. What is surprising, and deeply troubling, is that at no point in the fifteen years in which their world was falling down around them did the Pennsylvania state treatment providers, or any national group coming to the aid of the providers, file a lawsuit in state court demanding the treatment industry's rights under the law.
After all, what point is there in lobbying for legislation guaranteeing quality addiction treatment, if, when we get it, the treatment industry can't then get funded and organized enough to fight the inevitable fight that is sure to follow? Yes, it is indeed true that we are up against giants. The health insurance industry pockets well in excess of $100 billion a year in premiums, with insurance executives readily admitting - on a not-for-attribution basis, naturally - that they are primarily in the business of collecting the premiums and "not so much in the business of paying claims."
However, the treatment industry is a $12 billion a year business that is not without resources. Granted, much of the parity-style legislation on the books, or being proposed, contains highly vague language that might not be worth going to court to fight for anyway. But if we are ever again lucky enough to be given the kind of sledgehammer that was handed to us by Pennsylvania lawmakers in 1989, we need to be ready to pick it up and use it.