Christie Pressures Hospitals, Insurers to Cooperate on Anti-Addiction Measures

Against some resistance from healthcare and insurance providers, governor forges ahead with anti-addiction agenda

Credit: Governor's Office/Tim Larsen
Gov. Chris Christie at Cooper University Health in Camden yesterday
Gov. Chris Christie raised the stakes Tuesday as he continued to push his signature anti-addiction agenda, challenging hospital officials to do their part in order to make other reforms have a lasting impact on reducing the opiate epidemic in New Jersey.

Legislative staff is working to craft what Christie has called “the most aggressive law in the country in terms of providing access to care” — a mandate that would require up to six months of insurance coverage for addiction treatment, which has sparked some resistance from insurance providers. The powerful physicians lobby has labeled as “cruel” another element of Christie’s plan, which would limit initial opioid prescriptions to five days only.

Now Christie is taking aim at hospitals and healthcare providers, making clear that they are on his list of targets in this anti-addiction campaign. He said he didn’t want to mandate their participation in addressing the drug epidemic — but he would do so if they didn’t step up and provide greater treatment capacity.

“All the insurance coverage in the world won’t matter if we don’t have a bed to put that person in, if we don’t have a group of healthcare providers to give them the tools they need to recover from their addiction,” Christie said, calling on the leaders at the state’s largest healthcare institutions to take action so that patients aren’t turned away. Christie made his remarks at Cooper University Health in Camden, which was marking Cooper’s first year of regional emergency medical service.

“We need everyone to step up in this fight because our children [are] dying and it is unacceptable to me and I will not leave office saying ‘I wish I would have done this or that,’” he said.

According to the state Department of Human Services, which oversees addiction treatment programs, the state has licensed 65 private and nonprofit providers of inpatient care, which together offer nearly 3,000 beds. Another 316 facilities run outpatient programs.

In 2015, some 28,000 New Jersey residents went through addiction treatment and 1,600 lost their lives to the disease, a 22 percent increase over the previous year. Experts have said many facilities have wait lists of hundreds of patients and it can take two months to get an inpatient spot.

Christie has focused increasing attention on addiction issues in recent years and devoted most of his State of the State speech two weeks ago to the crisis. He outlined several measures to reduce its impact, including the insurance mandate and limiting opiate prescriptions. While many praised the governor’s passion and commitment to the issue, experts have questioned how his specific proposals could be implemented effectively.

For example, while Christie vowed the insurance mandate would apply to everyone, any reforms are likely to impact only one-third of the policies that cover state residents. And while six months of treatment may seem like a blessing to the family members of an addict, insurance companies said such benefits would drive up the costs of premiums. Some addiction experts noted a mix of inpatient and outpatient care may be most effective.

Jay Youtz, an intervention expert and marketing director with Recovery Centers of America — which operates four outpatient sites and a 53-bed inpatient facility, The Lighthouse, in South Jersey — said he regularly struggles to secure insurance coverage for patients at these facilities. “We’re fighting every single day to get these people in,” he said. “If it was cancer or diabetes, they’d be getting insurance.”

Once accepted, patients are rarely covered for more than two weeks, experts said. Six months of recovery “would be great,” said Youtz, a heroin addict who will be clean 29 years next month. “The longer the length of treatment, the better the chance of recovery. But that doesn’t just mean inpatient. Outpatient too,” he said.

That flexibility — backed by a guarantee of long-term coverage — may be reflected in the legislation now being drafted to implement Christie’s plan; the non-partisan Office of Legislative services has continued to draft the bill, which has yet to be made public. Those close to the process said it is likely to require insurance companies to provide up to a month of inpatient care without any delays, which can be renewed for another month during those first 30 days, based on a doctor’s order. It would also enable a patient to continue as an outpatient, attending programs on multiple days or nights a week, for a total of 180 days.

Few states mandate any inpatient care, let alone provide coverage for six months, experts said. New York requires 14 days of care, as does Massachusetts, and Pennsylvania appears to cover a week of detox and up to 30 days of inpatient care, plus outpatient treatment.

“Based upon my staff’s review of the laws across the entire country, they believe and have told me that this will be the most aggressive law in the country in terms of providing access to care,” Christie said in Camden. His office declined to provide more detail on any other legislation they had reviewed.

Christie also urged the Legislature to ensure the bill mandates coverage for medication-assisted treatment, which uses safer prescriptions to control an addict’s cravings; that patients would be protected against additional out-of-pocket costs; and that patients not face any delays or other barriers to care due to insurance requirements. He also wants the law to require the state Attorney General to monitor the system to ensure providers are not filling beds with long-term patients just to collect insurance payments.

The legislation — which Sen. Joseph Vitale (D-Middlesex) announced late Monday he would sponsor, along with Senate President Steve Sweeney (D-Gloucester) and Minority Leader Sen. Tom Kean Jr. (R-Union) — would also address Christie’s call to limit opiate-based prescriptions to a five-day supply, using language based on guidelines issued last year by the federal Centers for Disease and Control to reduce the availability of these drugs. While pain patients and some physicians fear this will leave them without options — and could increase heroin use — addiction experts note that four out of five heroin addicts first got hooked on prescription drugs.

Vitale suggested in a press release that the legislation would also be used to implement other steps that could help reduce addiction, including a requirement that physicians spell out the dangers of any opiate to their patients. Christie signed a similar law that applied only to patients under 18, but the Assembly had refused to back a version that would have included adults.

But efforts to mandate prescription supply or patient education is likely to face strong opposition from physicians, including the powerful Medical Society of New Jersey. And that could lead to some behind-the-scenes wrangling over the language, since the bill’s sponsors in the Assembly are likely to include Assembly Speaker Vincent Prieto, (D-Hudson), Minority Leader Jon Bramnick, (R-Union), as well as Assemblyman Herb Conaway, (D-Burlington) — a physician who has repeatedly made clear his opposition to government imposition on of rules about how doctors practice their craft.

“When a person addicted to drugs seeks help they cannot wait days or weeks for an insurance carrier to decide if they will cover the treatment. They need immediate help,” Bramnick said. “This comprehensive bill removes the barriers to treatment, and also addresses prevention and education.”