While Congress continues to hash out the details of a repeal of the Affordable Care Act, also referred to as Obamacare, mental health and addiction treatment advocates wonder how the repeal will affect those seeking care for mental health or substance abuse disorders. Just as the ACA expanded coverage to those in need, a replacement program may limit treatment for that same population. The potential far-reaching consequences of an ACA repeal have many in the addiction treatment industry concerned about exactly what the fallout might look like.
The Addiction Problem
Opioid abuse has fueled a growing addiction problem in the U.S. in recent years. According to the Centers for Disease Control and Prevention, 33,000 people died of an opiate overdose in 2015 alone. In fact, deaths related to heroin surpassed deaths related to homicides involving guns during that same year. The U.S. Surgeon General estimated nearly 94 million people admitted to binging on alcohol, abusing prescription drugs, or using illicit drugs during 2015.
The ACA and Addiction Treatment Coverage
In the midst of these alarming numbers, the ACA brought some hope. The Medicaid expansion in the act provided coverage for 1.2 million people struggling with severe mental illness or substance abuse disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that up to 30 percent of the individuals that received coverage with the Medicaid expansion had a mental illness, a substance abuse disorder or a combination of the two. The figure is higher than the 20 percent of the general population with one or both of these disorders, indicating the Medicaid expansion offered the necessary help to those in most need.
The ACA also currently requires insurance plans, including Medicaid plans, to provide coverage for addiction and mental health treatment. While this requirement does increase the costs of health plans somewhat, the cost is shared by the entire population of the insured, rather than falling solely on those in need of mental health and addiction treatment. This also makes treatment more accessible to thousands of Americans that might not be able to afford it otherwise.
Limiting Coverage, Limiting Access
If the Medicaid expansion was reversed, a change many in Congress currently support, it would mean many Americans would lose their insurance coverage. This would include their access to affordable mental health and addiction treatment services. The ramifications of that change have concerned not only Democrats in Congress, but also some Republicans. Four Republican senators drafted a letter to Senate Majority Leader Mitch McConnell to voice their apprehensions over such a move.
Waiving the requirement for insurance plans to include mental health and addiction treatment coverage would also likely have a negative impact. In this situation, it would be up to insurance providers and individual states to determine how much of these treatments would be eligible for coverage. Because both of these disorders are considered chronic and costly to treat, many fear coverage for these treatments would not be continued in many cases.
The Need for Responsible Reform
While it does appear a repeal of the ACA is a nearly inevitable reality, the replacement to the act should be responsible for caring for the most vulnerable members of our society. A spokesperson for the Treatment Advocacy Center was quoted by Politico as saying, “We strongly encourage policymakers to recognize that all decisions about health reform must consider and provide for the needs of the most severely mentally ill. Failure to do so will forfeit the momentum towards reforming our broken mental health system at tremendous human and financial cost.”