Insurance Plans Often Neglect People With Addiction

By May Wilkerson 06/10/16

A new report found that two-thirds of Affordable Care Act insurance plans fail to cover substance use disorder services.

Insurance Plans Often Neglect People With Addiction

If you have ever tried to get insurance to cover your addiction treatment, this may come as no surprise: insurance plans across the country are not covering necessary addiction-related services, according to a report released Tuesday by the National Center on Addiction and Substance Abuse. Especially in light of the country’s growing opioid epidemic, this lack of coverage could have dire consequences.

“Our findings reveal that people with addiction may not be receiving effective treatment because insurance plans aren’t covering the full range of evidence-based care,” said the report’s lead author Lindsey Vuolo, Associate Director of Health Law and Policy at the National Center on Addiction and Substance Abuse. “For example, our review did not find a single state that covers all of the approved medications used to treat opioid addiction.”

President Obama signed the Affordable Care Act (ACA) into law in 2010. In 2013, the law was put into practice, with millions of Americans suddenly being offered access to affordable health insurance. There are currently 12.7 million Americans insured under the ACA.

One of the principles of ACA was for health insurance companies to treat addiction like a disease, not a moral failing. But while the law has finally caught up with a more progressive understanding of addiction, insurance plans and states are still behind. A comprehensive review of the 2017 Essential Health Benefits (EHB) benchmark plans, which determine specific addiction benefits offered to people with ACA insurance, found that none of the plans are offering sufficient coverage for addiction-related treatment. And two-thirds actually violate the ACA, which requires plans to cover substance use disorder services.

Unfortunately, this is nothing new. Historically, insurance companies have failed to offer adequate services to people with addiction. And this lack of access to affordable treatment can lead to a whole range of health and social consequences for people suffering from addiction, including disability and death. It can also place a burden on taxpayers in healthcare costs, and lead to an increase in drug-related crimes. 

“We are still a long way from treating addiction like a disease,” said Samuel A. Ball, President and CEO of the National Center on Addiction and Substance Abuse. “Insurers are still not providing the same level of benefits for addiction treatment and services as they do for medical or surgical care. The absence of sufficient coverage for medication-assisted treatment for opioid addiction is particularly alarming given the number of people dying or suffering on a daily basis. This kind of healthcare discrimination would never be tolerated during an epidemic for any other life-threatening disease.”

The report urges states and insurers to update their plans in accordance with ACA requirements and to cover the full range of effective addiction treatments. Currently, states or insurance plans that do not comply with the law do not face any penalties. Until this changes, millions of Americans living with addiction could continue to be denied access to effective treatments. 

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May Wilkerson is a writer, comic and Managing Editor @someecards. Co-host of the podcast Crazy; In Bed w/alyssalimp. She is also the top Google result for "insufferable lunatic." Follow this insufferable lunatic on Twitter.