Medicare for All must include cannabis coverage

Posted on March 12th, 2019 by Bill Weinberg and tagged , , , , , , , , , , , , .

medical marijuanaInsurance companies in Canada are starting to cover medical marijuana, but high costs continue to be an impediment to access in the United States. Even in states that have legalized medicinal use of cannabis, the insurance industry will provide no coverage. Advocates are now starting to demand legislation to address this contradiction.

Growing demands for a "Medicare or All" solution to the United States' health coverage dilemma points to mainstream embrace of a progressive agenda that also includes legal cannabis.

The Bernie Sanders presidential candidacy brings these issues together. As the Washington Post reports, he has put a Medicare for All proposal at the heart of his campaign. And his criminal justice platform will include ending cash bail nationwide, abolishing private prisons—and  legalizing cannabis.

But there is an obvious link between these issues that only some are now starting to make: the high cost of cannabis is keeping it beyond reach for many even in states with medical marijuana programs. Advocates are starting to insist that cannabis will not have truly been liberated until it is covered in health plans, like any other legal medicine.

High costs: fatal flaw in medical marijuana programs 
Lawmkers in New York state, where a cannabis legalization measure is now pending,  State Sen. Diane Savino and Assemblyman Richard Gottfried, both Democrats from New York City, and pushing what the New York Post couldn't resist calling a "doobie-ous scheme" that would require government health-insurance programs such as Medicaid, Child Health Plus, Elderly Pharmaceutical Coverage and workers' compensation to cover cannabis as they would any prescription drug.

"It's unfair not to cover marijuana when opioids, OxyContin and Ambien are covered," Savino told the Post. "We have to push the envelope." The lawmakers say the idea would help address the opioid crisis that is gripping the state, like all too many across the country.  "For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids," Gott­fried told the newspaper.

This is clearly an issue nationwide. Minnesota has had a medical marijuana program since 2014. But the state's Bemidji Pioneer  newspaper writes that lack of affordable access is the program's "one major flaw." It cited state data showing that last year alone more than 3,400 new patients dropped out of the program, and attributes this in large part to the high cost of medicine.

Patients told the Pioneer they spend anywhere from $200 to $700 per month on the medication. These costs could be offset if insurance companies covered medical marijuana, but they will not do so until the federal Food & Drug Administration approves it, the Minnesota Council of Health Plans told the newspaper

If the measure pending in New York's legislature is approved, this will be a significant challenge to the federal government on the question.

This is also an issue in California, the state that pioneered legal medical marijuana with Proposition 215 in 1996. Ironically, "compassionate care" cannabis—that made available to needy medical users—as been dealt a blow by the general legalization approved by voters in 2016. The high taxes on legal cannabis have closed space for compassionate care. A bill to provide tax relief for medicinal cannabis failed to pass in Sacramento last year, vetoed by then-governor Jerry Brown.

Progress in New Hampshire
A breakthrough was reported from New Hampshire this month, as the Granite State's Supreme Court ruled that a labor appeals board had erred in its judgment that workers' compensation insurance cannot reimburse an employee for the cost of medical marijuana. As Insurance Journal reports, the court found that under the state's 2013 medical marijuana law, a carrier is not barred from reimbursing. It further found that a qualified patient is entitled to cannabis under state law. The court did send the case back to the workers' compensation board for further consideration of the effect of federal law on the question.

The case concerned Andrew Panaggio, who registered in the medical marijuana program after he hurt his back on the job  in 2016. He sought reimbursement through workers' comp, but his carrier, CNA Insurance Co, turned down the claim on the ground that "medical marijuana is not reasonable/necessary or causally related" to his injury. Panaggio challenged the denial before the New Hampshire Department of Labor—where a case officer sided with CNA Insurance.

Panaggio then appealed to the Department's Workers' Compensation Board. Following a hearing, the board acknowledged Panaggio's testimony that "cannabis is palliative and has the added benefit of reducing his need for opiates," unanimously finding that Panaggio's "use is reasonable and medically necessary." Despite this, however, a majority of the board upheld the CNA's refusal to reimburse Panaggio, because such reimbursement is "not legal under state or federal law." Following the high court decision, the state law argument, at least, is shot down.

Canada leads the way

Meanwhile in Canada, insurance coverage of medical marijuana is making big advances. Last year, Sun Life Financial of Toronto became the country's first major insurance carrier to offer coverage for cannabis. Sun Life chief executive Dean Connor said the move was prompted by rising demands from clients—especially those suffering from cancer, multiple sclerosis or rheumatoid arthritis, or those requiring palliative care. "Medical marijuana has become a very important part of their treatment program and pain management program," Connor told Canada's Financial Post 

And effective this year, the life insurance arm of Quebec's SSQ Insurance has started offering employers and other plan sponsors the option of covering medical cannabis, as TheGrowthOp cannabis industry site notes.

Even in Canada, it has been a long haul to this progress. The Canadian Broadcasting Corporation recently profiled the case of Melissa Ellsworth, who struggled against the bureaucracy for five years before the Workers' Compensation Board of Nova Scotia finally started paying for the cannabis she uses to treat chronic pain. She was finally approved in January 2018, after a tribunal found there was "sufficient evidence to conclude that the worker is entitled to medical aid in the form of medical marijuana."

Ellsworth frankly told CBC that the ruling saved her life.  "I can function every day like a normal human being instead of being crippled up in pain," she said. "I went from 26 pills a day to cannabis."

It will certainly be a far bigger struggle to win this kind of progress in the more puritanical United States. But it starts with advocates pushing to include cannabis coverage as a basic plank of the progressive agenda.

Cross-post to Cannabis Now

Graphic by Americans for Safe Access


Who's new

  • Baba Israel
  • Karr Young
  • John Veit
  • YosephLeib
  • Peter Gorman