It happened this morning…well…OK…it actually REALLY happened as soon as the law was passed, but now it’s happening again: the GOP has once again began undertaking efforts to repeal the Affordable Care Act. This morning, the Trump Justice Department issued a filing urging the Supreme Court to end Obamacare in its entirety. The move that will once again likely leave millions without health insurance, including those struggling to find drug and alcohol addiction treatment, and is something of a departure from President Trump’s previous inclinations toward keeping certain key provisions of the sweeping legislation that endeavored to cover the 44 million Americans who had no health coverage as of its passing in 2010. These provisions included keeping protections for Americans with pre-existing conditions and sustaining federal Medicaid expansions that were granted to participating states.
What Does Obamacare Currently Do for Those Seeking Addiction Treatment?
The Patient Protection and Affordable Care Act, known colloquially as the ACA or “Obamacare”, created two key avenues of access for those seeking addiction treatment. The first is the inclusion of behavioral health and addiction treatment into the law’s Ten Essential Health Benefits that every insurance company looking to opt into the ACA marketplace must cover. The Affordable Care Act’s requirement that essential health benefits be covered without annual dollar caps provides patients with more health benefits and a lesser financial burden.
Prior to the introduction of the Essential Health Benefits, one in three Americans had no coverage for substance use disorder treatment. Language in the ACA ensured that people with mental health or substance abuse disorders will have the peace of mind of knowing that their plan must cover their needs and that their coverage for these mental health services must be as comprehensive as their coverage for medical and surgical services.
Another way in which Obamacare facilitates access to addiction treatment is through expansion of Medicaid subsidies to participating states. In 2014, Obamacare increased the number of people who were eligible for Medicaid, many of whom need addiction treatment. It also included additional Medicaid dollars to fund state-sponsored addiction treatment programs. The Center for Budget and Policy Priorities indicates that 12 percent of Medicaid recipients currently suffer from substance use disorder.
Can They Really Do This?
The primary impetus for the repeal efforts comes from a federal judge in Texas’ ruling that the ACA was unconstitutional. Efforts to strike down the law may prove considerably easier since Congress removed the linchpin Individual Mandate portion of the law as part of the Trump Administrations’ signature Tax Reform bill last year. While the Individual Mandate was never the most popular aspect of Obamacare, it provided for the subsidization of many more beneficial components behind which a majority of Americans consistently backed in polls. As it makes it’s way before the Supreme Court once again, including Chief Justice Roberts who was the swing vote for the law’s preservation in a landmark ruling, it’s increasingly uncertain whether it will survive another round of judicial consideration.
What Does This Mean for Those Who Need Addiction Treatment?
As of now, employer-based, individual and family insurance plans are more apt than ever to cover addiction treatment; however, the repeal of Obamacare in its entirety may have a ripple-effect that impacts accessibility of coverage. This can not only dictate access to immediate coverage; but also residual and ongoing interventions like medication-assisted treatment plans, psychiatric therapy and other treatment modalities. In an era in which over 70,000 people per year are dying from overdose, many experts are concerned that limiting access and funding for treatment will lead to even higher rates of mortality.