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One of the major themes of the 2016 presidential election was employment. The issue of high unemployment in certain areas of the country rose to national prominence and President Trump promised to bring jobs to these communities. Various causes were cited for unemployment, including globalization, trade agreements, technology, and regulations. Yet there was one contributing factor that was not discussed: addiction.
How are addiction and unemployment related?
Late last year, Alan Krueger, an economist, published Where Have All the Workers Gone? This paper found that a large number of unemployed men of working age were taking prescription opioids. While the paper did not examine rates of substance use disorders, it is likely that there are higher rates of opioid addiction among this population. Addiction frequently prevents individuals from participating in active employment. In fact, untreated addiction creates a tremendous drag on the economy. If creating more jobs and improving the economy are major national priorities, they cannot be achieved without addressing our addiction crisis. And we cannot address our addiction crisis without health insurance that pays for treatment the same way it pays for the care of other chronic diseases.
Why is insurance necessary?
A critical step in addressing this crisis is to get people into treatment. Currently, only 10 percent of people with a substance use disorder receive treatment. This number is unacceptably low. Though lack of insurance coverage is not the single cause of the low treatment rate, it is a major and consistent obstacle to accessing care when addicted persons or their families reach out for help. In our health care system, insurance is essential for treatment access because it pays for health care services. Therefore, without insurance, people cannot access addiction treatment. This can subsequently prevent them from gaining or returning to employment.
What’s the connection to employment?
Historically, insurance has been deeply intertwined with employment for many Americans. Most employed, non-elderly people in the U.S. get their health insurance through their employer. This means people often lose health insurance when they lose their jobs, making it nearly impossible to access care. The Affordable Care Act (ACA) – commonly known as Obamacare – sought to address this by creating premium tax credits so people could purchase insurance based on their income and expanded Medicaid to cover all low income adults. This was meant to help provide access to the health care system during periods of unemployment. Now, despite their promises to help the unemployed, the White House and Congress have begun the process of repealing the ACA, restructuring Medicaid, and reducing benefits.
Krueger’s study and others suggest that unemployment, a lack of insurance, and substance use are major contributing factors to addiction. People with addiction often cannot work or look for jobs. The ACA and Medicaid in particular are vital resources to help unemployed people recover from addiction and get back to work by providing critical access to the health care system when it is otherwise inaccessible. Indeed, a recent assessment of Ohio’s Medicaid expansion found that having Medicaid coverage made it easier for individuals to look for and maintain jobs.
What can be done?
While it has not been mentioned as a way to promote job growth, treatment is vital for individuals who are unemployed and suffering from addiction. When people receive appropriate treatment, recovery is possible, allowing them to look for jobs and return to work. The ACA and Medicaid are often the only health insurance options for individuals who are unemployed. If we want more able and productive employees, we should promote individual and economic growth by creating pathways to help people with addiction instead of limiting their opportunities to receive care.
Lindsey is an Associate Director of Health Law and Policy at The National Center on Addiction and Substance Abuse