How the Affordable Care Act Impacts Addiction Treatment

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“There is no illness that will be more favorably affected [by the Affordable Care Act] than substance abuse. This is the beginning of substance abuse disorders being part of mainstream health care.” ~ A. Thomas McLellan, Director of the Treatment Research Institute in Philadelphia, and former US Deputy Drug Czar According to the US Surgeon General, Dr. Vivek Murthy, 1 out of 7 Americans will develop a substance abuse disorder at some point in their lives, but only about 1 in 10 will ever receive treatment for their problem. Traditionally, one of the biggest barriers to substance abuse treatment has been affordability, because drug and alcohol rehab can be prodigiously expensive for people without insurance. The Patient Protection and Affordable Care Act, commonly called Obamacare or the Affordable Care Act (ACA), was supposed to help with that very issue. But is there a downside to the impact that the ACA has had on addiction treatment? Let’s take a look at the positives and negatives of the Affordable Care Act.

How the Affordable Care Act Has Helped Addiction Treatment

For people needing professional help with a substance abuse disorder – alcoholism, illicit drug addiction, or the misuse of prescription medications – the ACA has helped them in several ways:

  • More people than ever before have insurance coverage—At least 9.5 MILLION previously uninsured people now have coverage.
  • Affordability— Because of the ACA, the out-of-pocket costs of drug or alcohol rehab are a fraction of what they once were. Anyone shopping for medical insurance can purchase an ACA-sponsored health plan. The five types of marketplace options include:
    • Bronze plans – 60 percent expense coverage
    • Silver plans – 70 percent expense coverage
    • Gold plans – 80 percent expense coverage
    • Platinum plans – 90 percent expense coverage
    • Catastrophic — 60 percent total average cost coverage (only available to people under the age of 30, and only under certain extenuating circumstances)
  • Guarantee of coverage –The government considers mental health and substance abuse services to be essential health benefits, so every marketplace plan must include coverage for:
    • Psychotherapy, counseling, and other behavioral health treatments
    • Mental/Behavioral health residential services
    • Substance abuse disorders

Furthermore, coverage cannot be denied for pre-existing mental or substance abuse conditions. And, because they are essential health benefits, there is no yearly or lifetime spending limit for the treatment of psychiatric or addictive disorders.

How the Affordable Care Act Has Hurt Addiction Treatment

“This is a general problem with Obamacare and does not necessarily apply only to addiction. You are either going to make treatment more expensive or harder to get into treatment. While for individuals who are able to get treatment this will certainly help them. But it will hurt the general population of those seeking treatment. This drives up treatment costs for everybody. Substance abuse is one of the most expensive benefit there is behind mental health treatment.” ~ Michael Tanner, senior fellow for healthcare policy research at the Cato Institute But as good as all of that sounds, there are still criticisms to be made.

  • Out-of-pocket expense – For 2017, the limit for an individual is $7150, and for a family, it is a thousand $$14,300. While that prevents catastrophic debt, it can still be prohibitive for many people.
  • Shortage of experienced service providers – The increase in the number of people with access to drug or alcohol rehab has created an unmet demand for more addiction specialists. Becky Vaughn, Vice President of Addictions at the National Council Formally Behavioral Health, says, “Our biggest problem right now is a lack of workforce. We’re ready to expand, we have new opportunities and new funding sources. But it’s all sort of moot if we don’t have the people to provide the care.”
  • Medicaid limits—A federal law restricts the number of beds a residential drug treatment center that accepts Medicaid can have to just 16. That means that larger facilities turn away patients who are using Medicaid to pay for their drug or alcohol rehab.

So, What is the Final Verdict About the Affordable Care Act and Addiction Treatment?

For all its issues, the Affordable Care Act has put millions of Americans in a much better position to get the help they need for their substance abuse and mental health disorders. Even in those individual circumstances were paying for drug or alcohol rehab might still be difficult, it is still a vast improvement over what was impossible just a few years ago. But perhaps the biggest positive of the ACA is how it is changing the public’s perception of addiction. Because substance abuse is now being treated as a legitimate medical condition, there is less stigma attached to those who need treatment. More people now understand that addiction is a disease, not a moral failing or a criminal predilection. Daliah Heller, who co-authored the American Civil Liberties Union’s Healthcare, Not Handcuffs and who works as a consultant specializing in drug policy reform, says, “If we view ACA as this document that is now federal policy… It’s sort of de facto recognition that it’s not a criminal justice issue. It needs to be addressed as a health issue.”