The Effect of ObamaCare on Treatment

By Marissa Rosado 04/21/14

The Affordable Care Act has gotten a lot of attention since it was first introduced, but how does it change options for treating substance abuse? The Fix offers some practical information.

Does it care for addicts? Shutterstock

The course of events that add up to a substance abuse problem are often complicated and traumatic. The acknowledgment of the problem and the decision to enter a treatment program can be more difficult. And yet the most challenging part of this process, for many, is life after rehab: addiction resolution and continued sobriety.

Rehab can be like a cocoon. But once treatment has ended and the addict returns to society without the structure and support of the facility, he or she often relapses. For recovering addicts, the maintenance of their sobriety is a challenge that dominates their life. Will addicts be able to find continuing care from programs covered by their health insurance plans? With the landscape of health insurance options changing rapidly within the last year, what exactly can recovering addicts count on?

Previous healthcare reforms for the treatment of substance abuse

Alcoholics Anonymous was founded in the US in 1935, but it took the American Medical Association until 1952 to define and acknowledge alcoholism. Case in point: we are used to a government that falls short and lags behind the issues regarding substance abuse.

After mental health insurance coverage was protected with the enactment of 1996’s Mental Health Parity Act, it took another 12 years to get it amended to include the Addiction Equity Act (its name in total, the MHPAEA). The act placed annual or lifetime dollar limits on the cost of treatment for recovering substance abuse addicts. This was a landmark move not only because it recognized the importance of supporting recovering addicts under current insurance plans, but also because it also prevented insurance companies from taking advantage of insured parties. Care for recovering addicts was guaranteed, and it looked like it wouldn’t cost an arm and a leg. 

Thanks to this legislation, the cost of substance abuse treatment was no more than the coverage for medical/surgical treatments allotted for in health insurance plans. While this doesn’t necessarily mean the treatments are affordable (especially for many in recovery, money is tight), it does provide a safety net for those seeking help. Copays, coinsurance, and out-of-pocket maximums are the same for someone treating heroin addiction as they are for someone with persistent seasonal allergies.

However: the MHPAEA did not make treatment for substance abuse a mandatory point of coverage for insurance providers. It also did not require plans to offer copays or any financial help for specific treatment of substance abuse, such as rehab programs or addiction resolution. So here is this terrific landmark legislation with giant loopholes embedded in it. This left a gap that left many in recovery without help or care.

The Affordable Care Act

In 2010, President Obama signed the Affordable Care Act (“Obamacare” or “ACA”) into law. In late 2013 and continuing this year, the law has finally been put into practice. Millions (7.5 million, actually) of previously uninsured Americans now have health insurance. One of the tenets of the ACA is to increase the quality and affordability of health insurance. Another is to reduce the cost of healthcare for the government and insurable parties. So what does this mean for those seeking substance abuse treatment?

The good news

In a groundbreaking move, the ACA has declared the treatment of substance use disorders an essential health benefit. Where the MHPAEA fell short, the ACA is picking up the slack. Addiction recovery is now seen as a critical component to physical health. Now many more will have access to rehab programs. More in need of that treatment will receive it, which will decrease the number of abusers and, hopefully, the number of relapses.

The logic behind the ACA’s prioritization of treating substance abuse is simple dollars and cents: previously untreated addiction costs the tax payers billions of dollars accrued through privatized health care and law enforcement. Ideally, having addiction treatment covered will eventually save this country money and diminish the strain on law enforcement occupied with drug related crimes.

The methods of treating people with substance abuse under the ACA reflect a new approach. The law largely promotes the idea of preventative care. Previously, addicts were treated when they “hit bottom," when it was apparent to every outside perspective that the person needed help. Moving forward, the ACA will treat substance abuse the way it should be treated. This will include disease prevention. Think of all the campaigning to prevent obesity that’s sprung up in the last decade. Now think of that attention applied to preventing substance abuse. The ACA also promotes earlier intervention to prevent the addicted person from ever hitting bottom. The act also offers several treatment options when the insured party seeks care for their addiction.

An example of the advanced perspective of the ACA can be found in the way alcohol abuse is addressed. Screening and counseling for alcohol abuse is now considered preventative care, and under the ACA, preventative care must be fully covered. That means no deductible, co-pay or co-insurance for an insured party. People seeking care for alcohol abuse won’t be penalized or unnecessarily charged.

More good news: if someone has a history of substance abuse and is afraid of being disqualified from eligibility, there’s nothing to fear. Under the ACA, an applicant cannot be deemed ineligible for insurance based on a pre-existing condition. Under this law, substance abuse counts as a pre-existing condition; candidates cannot be rejected from the exchange based on previous drug abuse. Think of what this will mean to thousands battling drug and alcohol abuse: full health insurance, access to proper care, and a fresh start.

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