Pre-existing Conditions Deserve Affordable Treatment

This article, in a slightly edited form, first appeared on Pain News Network on October 3, 2019.


The National Institutes of Health (NIH) reports that at least ten percent of Americans experience a substance use disorder (SUD) at some point. Seventy-five percent of those who suffer from an SUD receive no treatment. An even larger percentage of Americans experience chronic pain. Most of them cannot find adequate treatment or even someone who will treat them..

Making treatment accessible for both these conditions—which are defined as pre-existing, for insurance purposes—is always a topic of concern. These days, it is of paramount concern that access to treatment is available, and it requires us to take action.

We Are All at Risk for Pain and Drug Abuse

Poverty and hopelessness are risk factors for drug abuse, even though not everyone who is economically challenged develops an SUD. Unfortunately, prevention and treatment programs for SUDs are less available to those who cannot pay for them and who most need them.

Anyone can suffer from chronic pain, but even those with resources may not have access to adequate pain management.

My concern is more than theoretical. It is personal. I have friends, former patients, and family members who suffer from SUDs. If the Affordable Care Act (ACA) ends and we lose coverage of pre-existing conditions, I fear they will be abandoned in exactly the same way as people in pain have been abandoned since the Center for Disease Control and Prevention issued their 2016 opioid prescribing guideline.

In recent years, I have received hundreds of emails and calls from people in pain. Their medications have been tapered, and they don’t know where to turn for help. Untreated chronic pain, as well as untreated SUDs, can result in ruinous consequences: disability, destitution, isolation, poverty, and suicide.

Education May Be Part of the Answer

We need to help people who work in healthcare find more effective ways to treat their patients. The Centers of Excellence in Pain Education (CoEPEs) program was created to teach healthcare professionals about pain and its treatment. Since this is something most doctors do not study during medical school, it’s important to have continuing medical education opportunities to learn about the stigma associated with pain treatment and substance abuse disorders.

Reversing the Affordable Care Act Could Have Devastating Consequences

The current administration has appealed to the Supreme Court to abolish the Affordable Care Act (ACA). President Trump has said that Obamacare “must fall.” Given the fact that we’re in the middle of a pandemic and millions of people are unemployed, and they may have lost access to employer-sponsored healthcare, the timing seems terrible.

However, reversing the ACA at any time would be devastating for millions of Americans who have an SUD or pain. Both SUDs and pain would be considered pre-existing conditions. The President signed an executive order on September 24 that claims to protect people with pre-existing conditions. However, experts dispute whether this executive order can actually do what it promises.

Regardless, eliminating the ACA will likely allow insurance companies to charge higher rates for people with pre-existing conditions. This would essentially render treatment for chronic pain and SUD unaffordable for most people, leading to an increase of the terrible consequences mentioned above. And, of course, SUDs and chronic pain are only two of the pre-existing conditions that would no longer be protected.

It is time for everyone to understand the consequences that losing the ACA may have for their community, family, friends, and themselves. There is still time to be heard, but you have to act quickly. Click here to find your federal, state, and local elected officials and express your views.

Let us also send healing thoughts and prayers to President Trump, the First Lady, and everyone else infected with COVID-19.


Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, The Painful Truth,” and co-producer of the documentary,It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.

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