There’s a young couple in Washtenaw County trying to get off heroin. They say so far, they’re doing great. After 22 months in treatment, she’s going to community college and he says he’s working at a high-end grocery store.
They’re just two of the 20,000 low-income Michiganders who now have free access to drug treatment.
But because it’s tied up with the Affordable Care Act, nobody knows if it’s going to last.
By 7:00 Thursday morning, the methadone clinic is already bustling
Ann Arbor Treatment Services opens at 5:30 on this dark, chilly morning. It’s in a beige-brick Ann Arbor Strip Mall, right behind a Starbucks and a mile and half down the road from Whole Foods and Lulu Lemon.
Rorry Niles, 31, and his girlfriend, Tabitha Parker, 25, pull into the parking lot early. Their dogs Sputnik and Penelope wait in the car for their daily walk.
The clinic is already doing a steady business, with people in parkas stopping in on their way to work. Little kids in snow boots can wait at a child-sized table, next to the toy shelves, for their parents to take them to school.
This methadone clinic feels like a cross between a doctor’s office and a DMV: clean, bright, sterile. Clinics just like it are popping up all over the state, especially in Southeast Michigan. Some of them, like this one, are corporate, and hope to eventually make a profit off helping people caught up in the opiate crisis.
The methadone here looks like cherry cough syrup. It’s a narcotic that helps wean people off heroin and pain pills. And because it’s so strictly regulated, people have to come in every day at first, where staff can hand them a dose and watch them swallow it.
Still, that’s better than what Niles and Parker were trying before, they say, over and over again. They’d stop using, and be so ill they could hardly function.
“We tried so hard to get clean cold turkey,” says Niles. “You know like, literally three days of hell, you know? And then you’re good for a week. And then, it’s like, oh you see an old friend or something and it’s like, ‘Hey let’s go get high.’”
“We couldn’t get jobs,” Parker says of that rock-bottom time. “For almost four months, we were living in our car, sick every day. Trying to get enough money to get drugs.”
Parker says she started stealing, and wound up in jail for three months.
Niles waited for her, living in the car that whole time. When she got out, they started getting medical assistance and going to a methadone clinic. There are good ones and bad ones, they say. Some are tiny offices with needles scattered in the parking lot, lines out the door, and 2,000 patients.
But this one’s pretty good, Niles says. They butt heads with the staff sometimes and Parker wishes they’d lighten up on all the restrictions about when they can travel (that requires taking daily dosages with them in a locked box). But the vibe is fairly friendly.
The game changer: 20,000 Michiganders get free access to substance abuse help
It seems like just about everyone at the clinic is on Medicaid. When Tabitha Parker mentions that their dentist suddenly stopped accepting Medicaid, a guy in the waiting room says the same thing happened to him. He knows a dental clinic nearby, he tells her, that still takes Medicaid.
Normally, a week’s worth of methadone will cost close to a hundred bucks. But for Parker, Niles, and a lot of the patients here, it’s free.
Back in 2014, Michigan expanded its Medicaid program as part of the Obamacare rollout.
Medicaid is health insurance for low-income people. Under the expansion, people qualify if they earl less than 138% of the federal poverty limit (in other words, a single adult making about $16,000 a year.)
That expansion was a game changer for substance abuse treatment.
More than 600,000 Michiganders got Medicaid under the expansion. And some 20,000 of them are using it to cover drug treatment, according to the state.
They can take that insurance to get help at a doctor’s office or get methadone at clinics, rather than having to wait for weeks just to get into a free treatment center, says Marci Scalera, who oversees substance abuse treatments for four counties.
“So it could be a matter of life and death if we’re waiting more than a couple days,” she says, remembering how before the expansion, they’d have to ration out grant funding and prioritize patients on wait lists, people who were pregnant, for instance, or who were about to lose their kids to the state because of drug use. “The difference of a day, could be the difference between living or dying.
“Especially those who are now addicted to opiate medication or heroin, the risk of overdose is significant. So somebody who comes to us and says, ‘I’m ready for care,’ that’s the time that you want to get somebody in as quickly as possible. The problem is, if we don’t provide those services, people go back out, they’re continuing to use, their motivational level drops, and we’re chasing them to get them back in. “
Now, instead of scraping by, they’ve got breathing room, she says. Scalera’s organization even helped local law enforcement buy Narcan, which can resuscitate people who’ve overdosed – the kind of thing Scalera’s group wouldn’t have been able to afford before the Medicaid expansion.
But that could change.
The uncertain future: repeal, replace and…what?
Governor Snyder is a big supporter of the Medicaid expansion and wants to keep it.
But nobody knows if that’s going to happen as Republicans figure out how to repeal and replace the Affordable Care Act.
Tabitha Parker is freaking out about that, wondering if she’ll be able to keep getting treatment while she finishes community college.
“I am feeling scared, because of my student tuition and having to pay for books,” she says. “Trying to get an actual real degree! So I don’t have the extra 70, 80 bucks a week here to pay for my methadone that should be covered under the Affordable Care Act.”
Still, other people in the drug treatment community are a lot less worried.
“I don’t know if the sky is going to fall, and I don’t think anybody else does either,” says Sheila Burns, the Executive Director of Ann Arbor Treatment Services – that’s the methadone clinic Niles and Parker attend. She’s worked in the substance abuse treatment field for years. “And I just feel like, there’s a very strong community of people, particularly with opiate addictions…[and] there’s a huge investment in this in this community. And if Washtenaw County can’t come up with a way to finance this? Then I think the whole country’s in trouble.”
But frankly, Burns says, she doesn’t think funding for treatment is about to disappear overnight.
“I have to say first of all, that it’s kind of farcical that it might play out that way,” she says. “Even if Obamacare is repealed, there’s going to be some kind of replacement of some kind. It might not include Medicaid expansion! I have no idea, no one does. If we reverted to what we were before, then this treatment, a lot of it depends on how the money is allocated by the county. And I would think this service would be one of the first ones covered, to be honest, because it is one of the most costing to the community.”
But if the Medicaid expansion is rolled back at the federal level, then Michigan will probably have less funds available for drug treatment overall, according to some experts.
Marianne Udow-Phillips is the Executive Director of the Center for Healthcare Research and Transformation. They’ve analyzed the various proposals floated by Paul Ryan and other Republicans to replace the Affordable Care Act.
“There is very little question that over time, maybe not initially, they will provide less money to the states,” she says. “In fact, some of the estimates that have been made through the Congressional Budget Office, say that by 2026, federal funding in total for the country for Medicaid, would be 33% less under a block grant proposal that’s been made, than under the current structure.
“So over time it becomes a cut in funds to states. And the states either have to make up that money, or reduce the number of people they’re covering. Or reduce the number of services that people get.”
For now, though, Rorry Niles and Tabitha Parker are trying to just stay focused on their recovery.
“We’re fortunate,” Niles says. “I’m excited. It’s been ten years for me. Getting skating, getting injured, getting overprescribed OxyContin…”
“That’s what we’re reaching for,” Parker says, hoping they can gradually reduce their clinic visits and just go to work, go to class, and take the dogs for walks by the river. “That’s what we’re ready for. It’s already there for us.”