When the “United” States Block People From Getting Treatment

It is a strange thing to live in a country called the United* States and realize just how disjointed, divided, and bureaucratically fractured our healthcare system truly is. Nowhere is this more painfully obvious than in mental health and substance-use treatment. We’re talking about when a person’s survival can depend on something as arbitrary as a state line.

Massachusetts and New Hampshire have cities very close to one another. People commute across the border daily. They shop, work, visit family, seek medical care, and attend community events without ever thinking twice about it.

When a person is trying to seek treatment across this border, it is more difficult than scaling a

massive barbed wire wall.

A person with NH Medicaid cannot get treatment in a MA facility, even if the bed is open and the crisis is urgent.

A person with MassHealth cannot enter a NH facility, even if it’s the safest or closest option. Even private insurance companies, which advertise themselves as large national networks, often behave like completely different businesses depending on which side of the border you stand.

And for what reason?:

X Not medical capacity.

X Not clinical judgment.

X Not public safety.

X Not cost savings.

The only reason is this: states and insurers refuse to align their rules. It’s time for people in the field, and in our communities to shout from the rooftops. This is wrong, and we can fix it through communication and a little bit of compassion.

These barriers are not natural. They are not inevitable. They were created by policymakers who never imagined that addiction treatment would become a life-or-death daily emergency for millions of Americans. They were created by bureaucracies that treat healthcare like a territorial game, where paperwork matters more than people. Please take a second and think about how outrageous this is.

We live in a region where overdoses don’t “respect” state borders. Mental health crises don’t “respect” state borders. Trauma, homelessness, and substance use don’t “respect” state borders.

But insurance rules do, and they do so rigidly, pointlessly, and often fatally.

If a bed is open, why should any state or insurer prevent someone from accessing it simply because they were born, lived, or worked on the other side of an invisible line? This is not patient-centered care.

It is not rational healthcare policy. It is bureaucratic stubbornness masquerading as governance.

The solution is not complicated. It does not require new science, new funding, new complex/liberty- restricting laws, or new technology. It requires reciprocity through mutual agreements between states and insurers to honor one another’s coverage for essential behavioral-health services.

• We already do this for driver’s licenses.

• We already do it for marriage licenses.

• We already do it for college credits.

We do not do this for substance use or mental health treatment.

A person in crisis should not need to understand Medicaid coding, interstate credentialing, or licensing reciprocity. Treatment centers shouldn’t need to jump through out-of-state hoops that make it financially implausible to take care of a human being.

They should not have to wait for an insurance committee to decide whether a nearby facility in another state is “allowed” to help them. They should not be turned away from treatment because two state governments could not coordinate a system built on basic human compassion.

• This shouldn’t be a heavy lift.

• It shouldn’t be controversial.

• It shouldn’t even be a debate.

If states truly believe in addressing the overdose crisis and they truly believe in reducing incarceration, homelessness, and emergency room strain . . . then opening access to treatment across state lines is the lowest-hanging fruit they could possibly pick.

America does not suffer from a lack of treatment beds. It suffers from a lack of communication, coordination, and common sense.

We cannot call ourselves a united nation while forcing people to suffer or die because they sought help two miles in the “wrong” direction.

It’s time for state leaders to fix what is obviously broken. It’s time for Medicaid and private insurers to stop protecting their administrative turf and start protecting human life. It’s time for us to act like the united country we claim to be.

Until then, the border between New Hampshire and Massachusetts will remain more than a line on a map. It will remain a barrier to treatment, a barrier to recovery, and, far too often, a barrier to survival.

Nothing changes until we get loud about it. Representatives of the people will respond when we get loud enough.

You know what you can do, but the question is: will you do it?