Some private insurers don’t cover effective treatments.
ALBANY, N.Y. – Fifty-four years ago, the Rev. Peter Young warned New York legislators about the ravages of heroin in some of the poorest, most desperate corners of Albany’s inner city.
Their answer: “That’s only a Harlem problem, Father. Don’t worry about it,” the state Senate’s chaplain recalled.
But now the drug is making a deadly resurgence in the region’s suburban and rural communities, and gaining headlines with an unusual twist: The poor are at times in a better position to get treatment than the kids from middle-class suburban families who have increasingly fallen under the spell of the addictive narcotic.
The problem, several witnesses told senators this week, is that private insurers often refuse to cover the most effective form of treatment: long-term inpatient care.
‘The best chance of success’
Albany County probation officer Darcy Katz testified that “the insurance barrier is just so high” that she sometimes urges young addicts to move out their parents’ homes so they can qualify for Medicaid, the public insurance program for the poor, to get the treatment they need.
It’s “the best chance of success that I’ve seen,” Katz said.
The fact-finding session was headlined by two grieving mothers who recently lost children to heroin overdoses.
It came less than a week after a 17-year-old Shenendehowa High School student was charged with allegedly injecting a 15-year-old classmate with the drug in the boys’ locker room.
If there is an upside to that shocking case, Colonie Police Chief Steven Heider told the panel, it’s that it will force the community to confront an ugly problem that police, paramedics, emergency room workers and addiction specialists have seen brewing for several years.
“Suburban people have a habit of closing their eyes,” Heider said. “The obituaries in the paper aren’t doing it, and we need the public involved.”
One of those obituaries was for Laree Farrell-Lincoln, who died of an overdose in March less than a week shy of her 19th birthday. She had been using heroin, which police say is cheaper and more potent than ever, for only four months.
One of the roadblocks that her mother, Patricia Farrell, initially hit when trying to get her daughter treatment was that her insurance company initially refused to cover more than two days of detox.
“They weren’t willing to cover inpatient” care, Farrell said. “How do you get an addict to complete outpatient care?”
How to define treatment
State Sen. Kevin Parker said the issue is personal for him. His brother, who used heroin in the 1980s, died from AIDS — a disease long associated with intravenous drug use.
The federal Affordable Care Act requires insurance coverage for drug treatment, but what exactly that requirement means in terms of programs offered by individual insurers is not explicitly laid out.
“It’s the opposite of what’s usually true — that poor people get the requisite coverage here and kids from the suburbs might not,” said state Sen. Neil Breslin, a Democrat and the ranking member of the Senate’s Insurance Committee.
Breslin said the Legislature can use its power to interpret insurance policies. If that doesn’t work, he said, lawmakers can consider a mandate similar to one in 1997 requiring insurers to cover chiropractic care.
“Too often, a crisis exists before legislators are able to do anything about it,” Breslin said.
Other witnesses backed programs, such as those at Catholic Charities and Albany Medical Center, to boost access to naloxone.
The drug can be administered nasally by friends and relatives to reverse the effects of acute overdoses involving heroin and prescription painkillers, which experts say have increasingly been a gateway to heroin for suburban youth.
A pilot program in parts of New York that expanded access to naloxone from paramedics to providers of lower levels of life support, like emergency medical technicians, helped reverse some 200 overdoses in its first year, said Dr. Michael Dailey, an emergency room physician at Albany Medical Center Hospital.
Based in part on that success, the state Health Department this fall approved the use of naloxone by basic life support providers, including most community ambulance squads.
“We need to get naloxone out there,” said Peter Berry of the Colonie EMS Department. “This is a medication that can save lives.”
Brenda Auerbach, whose 20-year-old son, Jeremiah, overdosed in October 2012, said she wished she had access to naloxone when she found him fatally stricken.
Nonmedical personnel have been allowed to administer naloxone in New York since 2006, but access problems and the need to train people to administer it have limited its reach.
“It would have been an option,” Auerbach said. “Instead of me frantically waiting for the ambulance to get there.”