The core compromises essential to getting it done were the usual “states rights” revenue split and later limiting state liability by abusing social security disability. There’s alot of overhead dollars that fund state operations so it is difficult to effectuate change - by design.

Things like addiction support are aligned with mental hygiene and Medicaid, so you really need to destroy your life until the safety net kicks in. If you live in a place like Mississippi, they’ll try to ship you north or push you towards SSDI (ie the Federal budget). In states that are less bleak, the community standard for disability is lower, and usually rehab is covered in some way by Medicaid.

The other thing that’s different about addiction vs regular healthcare is that the person needs to be ready. I worked for years with a gentleman who beat alcoholism and became a counselor. He was only able to get by it after harming one of his children accidentally.