Tuesday, Sep 18, 2018
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Challenge to Affordable Care Act threatens Lucas County services


    Richard Dugan, a recovering drug addict, says recent challenges to the Affordable Care Act's protections for people with pre-existing conditions could change their ability to access behavioral health services.

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    Richard Dugan.

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After fighting addiction for 21 years, Toledo resident Richard Dugan is finally clean.

Through 15 months of intensive therapy and frequent trips to the methadone clinic, he’s kicked his heroin habit and started working 30 hours a week.

But last week, when the U.S. Justice Department said it will no longer defend key components of the Affordable Care Act intended to protect patients with pre-existing conditions, Dugan began to worry that his life would unravel again.

“If they take away my benefits, then I’m definitely in trouble,” Dugan said. “I’m just getting back on my feet. I don’t need all that.”

The department’s decision to side with Texas and 19 other states in a case filed in federal district court in Fort Worth threatens Lucas County residents with pre-existing conditions, and health-care service providers like the Zepf Center, the Toledo-based behavioral health non-profit where Dugan went for treatment.

VIDEO: Richard Dugan

If the court rules against the ACA’s patient protections and individual mandate, insurance companies would be allowed to charge prices unaffordable to people like Dugan with pre-existing conditions including substance addiction, asthma, diabetes, and cancer.

Dugan makes $11 an hour working at Tim Horton’s and as an RA at the Zepf Center. After paying rent and child support, he wouldn’t be able to afford the methadone and other medicine he depends on without coverage, he said.


Richard Dugan, a recovering drug addict, says recent challenges to the Affordable Care Act's protections for people with pre-existing conditions could change their ability to access behavioral health services.

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Scott Sylak, executive director of the Lucas County Mental Health and Services Board, said that the ACA’s expansion of Medicaid, which was also challenged by the Texas suit, has freed up funding for the board to offer wide-ranging services beyond just standard health care to the 32,000 county residents in its system.

“If the potential loss of expansion would occur, that would severely restrict the board’s ability to fund services beyond our required treatment continuum,” Mr. Sylak said. “Things like justice reform, things like housing, all those things would be compromised because we’d have to funnel towards treatment services that are covered by Medicaid currently.”

Mr. Sylak added that if patient protections for consumers dealing with substance abuse were revoked, addiction prevention services funded by the board would suffer.

“Policymakers who go on record saying we want to address the heroin and opioid epidemic but then say in the same breath we want to eliminate Medicaid expansion aren’t looking at the whole picture,” he said. “That is a big concern for the board.”

Zepf Center CEO Deb Flores said the ACA’s protections have allowed her organization’s treatment centers to become more accessible and invest in publicity.

“People who previously didn’t have health care wouldn’t have come in because they didn’t think they could get treatment,” she said. “It’s opened up awareness.”

The decision to join the case in Texas is a rare departure from the justice department’s practice of defending federal laws in court. 

Attorney General Jeff Sessions said in a letter to Congress last week that President Trump approved the legal strategy.

Texas and other Republican-led states are suing to strike down the entire law after Congress recently repealed a provision that people without health insurance must pay a fine. The repeal takes effect next year.

Texas has argued that, without the fine in place, the requirement to have health insurance is unconstitutional and the entire law should be struck down.

Rea Hederman, vice president of policy at The Buckeye Institute, said the Affordable Care Act in a broader sense has hampered Ohio’s health insurance market.

The number of companies offering health insurance in Ohio has dropped from 17 in Ohio in 2016 to eight this year, according to the Ohio Department of Insurance.

“Because we’ve had very few benefit regulations, insurers have raised premiums or left the market altogether,” Mr. Hederman said.

For now the signature Obama-era law remains in place, and as Texas vs. U.S. plays out in court, Dugan wonders about how the outcome of the case could define his recovery.

“My addiction was getting out of control, I was stealing from my family, I was stealing to support my habit, I was facing jail time, and people didn’t want me around,” he said. “I finally got my kids’ respect back.”

Blade news services contributed to this report.

Contact Mark Rosenberg at mrosenberg@theblade.com or 419-724-6194.

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