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A far-reaching national expansion of gambling is setting the stage for more people to take their chances: The tap of an app can now win them thousands of dollars on the Warriors game or at the race track.
The odds, though, that someone with a gambling problem spends their last paycheck on that bet—instead of covered treatment options that are few and far between—may have just gotten higher.
About 5 million Americans are problem gamblers, according to the National Council on Problem Gambling. And the Supreme Court’s May 14 decision in Murphy v. NCAA to open up legalized betting on individual sports events could see that number rise. A limited infrastructure exists to stop people from falling through the cracks, and once they find themselves in need of treatment, health-care options that are paid for by insurance are sorely lagging, according to professionals in the field of problem gambling.
Opening up new avenues for betting will likely add fuel to the fire unless more is done to build and fund a treatment safety net, they said.
Just $7 million of the approximately $117 billion in gambling revenue goes to treatment, Keith Whyte, executive director of the National Council on Problem Gambling, told Bloomberg Law.
“The safety net is tattered in most states and nonexistent in others,” Whyte said.
Private health insurance companies historically haven’t paid for problem gambling treatment and generally only cover the services now when they’re accompanied by a mood disorder such as anxiety or depression.
Medicaid is the nation’s largest mental health payer, yet its coverage of problem gambling treatment is more spotty.
The health insurance program for the poor usually pays for some outpatient therapy and evidence-based treatments such as motivational interviewing and cognitive behavioral therapy, according to Kitty Purington, a senior program director at the National Association of State Health Policy.
The outpatient benefits are required to be as robust as physical outpatient treatment in states that have moved their programs into private managed care plans because of parity laws, she told Bloomberg Law in an email.
Oklahoma negotiated with the Centers for Medicare & Medicaid Services to offer a host of services under the problem gambling umbrella, according to the National Council on Problem Gambling. But Whyte said just a few states have followed suit, and most don’t offer the coverage. The law—even Obamacare’s parity requirements—doesn’t cover that level of specificity on addiction, so states need CMS permission to go down that road.
A National Council on Problem Gambling research paper on gambling treatment services as they stand encourages advocates to explore Medicaid coverage options: “Working toward Medicaid coverage offers the chance for immediate tangible benefits—that is, problem gambling coverage for Medicaid enrollees—and a promising ‘foot in the door’ for eventual coverage by private payers,” the paper said.
The move would also increase federal support that could eventually extend across Department of Health and Human Services programs and rules, the group said.
“People with gambling problems are the most disadvantaged group in terms of health-care coverage in the U.S.,” Whyte said. “There’s enormous shame and stigma and more laws prohibiting them being covered than those that support or allow problem gambling addiction coverage.”
No federal money goes to national prevention or research efforts, he added.
Increasingly, states that have legalized gambling are creating their own programs using money from the increased revenue to fund health care. Addiction treatment is generally stronger in those states, the professionals in the field said.
Maryland, for example, created the Center of Excellence on Problem Gambling after the state expanded legal betting. The center offers a fund directed at awareness and research, and it also pays for treatment services Medicaid won’t reimburse.
In New Jersey, too, then-Gov. Chris Christie (R) mandated operators to include responsible gambling features to reduce problem gambling and yearly evaluations of their success, Lia Nower, director for the Center for Gambling Studies at Rutgers University, told Bloomberg Law. Atlantic City’s casinos are a hot-spot for gambling, with the state raking in $2.56 billion in gross gaming revenue in 2016, according to the American Gaming Association.
“You have to get the harm reduction into the legislation authorizing it at the beginning,” Nower said.
About $71 million went to the gamut of problem-gambling services from prevention to research, according to a 2016 National Council on Problem Gambling survey. On average, that translated to $0.23 per capita in states that offer their own funds.
Ten states won’t use any public funds to curb gambling addiction, according to Whyte.
Patient treatment advocates in this space are concerned that the high court has opened the doors to more gambling with little assurance states having enough safeguards in place.
“People are recognizing gambling is no longer a state-by-state issue,” Whyte said. “It’s a national policy issue, and problem gambling is a national public health issue. It needs to be addressed with that same seriousness.”
The American Gaming Association counts the ruling on sports betting as a win for the industry: For its part, the group also says it will work with stakeholders on a new regulatory environment that “capitalizes on this opportunity.”
“Through smart, efficient regulation this new market will protect consumers, preserve the integrity of the games we love, empower law enforcement to fight illegal gambling, and generate new revenue for states, sporting bodies, broadcasters and many others,” the trade group said in a statement on the court decision.
There are also no national agencies dedicated to the addiction, unlike those focused on alcohol and substance use in the National Institutes of Health.
Complicating matters is a lack of treatment centers qualified to offer inpatient and outpatient gambling treatment services, Nower said.
Many don’t offer help from people who are trained in this kind of addiction, she said.
The federal government needs to treat gambling in the same light as addictions to heroin or other substances, she said. Nower cited a need for more education to raise awareness of the problem’s seriousness.
People dependent on gambling rack up about $6.5 billion annually in health-care and criminal justice costs, according to Whyte. That includes heart problems stemming from stress and often white collar crimes used to fund the habit.
“It is a hidden public health issue,” Nower said. “Unlike drugs, by the time you have a serious problem you have already potentially bankrupted yourself and your family, lost your home, lost your job, and perhaps you’ve stolen or embezzled, or robbed a bank.”
Sports betters are generally young, most commonly 25 to 34 to years old, according to one 2017 Rutgers survey on the prevalence of gambling in New Jersey. They’re the gamblers who are more likely to use their cell phones and tablets and can bet anywhere at the drop of a hat.
The group was also the most likely to be “high-frequency” gamblers (once a week or more), with 68 percent at risk for developing a gambling disorder.
Further, people who use more avenues to bet (such as online, in casinos, and at sports events) tend to develop an addiction at higher rates.
Nower said the data underscore the need for a framework to reduce harm before gamblers hit the extreme lows of gambling compulsion. She hopes to see that in legislation.
Whyte added that he’s optimistic the Supreme Court ruling might pave the way for soul-searching and more actions to take responsibility and improve the care safety net.
“If we’re going to start taking gambling seriously now that we have the biggest national expansion in our history, it’s a good time to take problem gambling seriously too,” he said.
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