Politics keeps interfering with substance use disorder policy, including addiction treatment, but progress is being made. The question is if it will continue.
The 2008 Patient Protection and Affordable Care Act (ACA)—more familiarly known as “ObamaCare”—required that insurance coverage include 10 Essential Health Benefits including “Mental health and substance use disorder services, including behavioral health treatment.” How has that been working out?
A good start, says FAIR Health, a nonprofit. From 2007 to 2017, insurance claims for all behavioral health diagnoses increased 320 percent, while treatment of drug abuse and dependence increased by even greater amounts, including amphetamine (3,157 percent), barbiturates (2,233 percent), hallucinogens (2,055 percent), and cannabis or marijuana (585 percent).
(Oddly enough, the preliminary results reported did not include a figure for opioid addiction treatment, despite the nearly 48,000 opioid overdose deaths last year.)
That rate may decline, however, because of a Dec. 14 ruling in Texas v. United States of America (also known as Texas v. Azar) that the ACA’s Individual Mandate (the requirement that everyone must have insurance or else pay a penalty) is “unconstitutional”, that the entirety of the ACA is “inseverable” from the Individual Mandate, and therefore that the whole ACA is likewise unconstitutional.
That means it threatens all provisions of the ACA, including pre-existing conditions and essential health benefits. The Mental Health Parity and Addiction Equity Act of 2008 provides some protection, but with huge gaps that ACA helped fill.
Not that it goes in to effect immediately. It will be appealed, possibly all the way to the Supreme Court, and will likely be reversed. The GOP state attorneys general—and likely the majority of the US House and Senate—may prefer that. They only wanted the Individual Mandate thrown out. Even the judge may not want his decision to go into effect.
A June 2017 tracking poll by the Kaiser Family Foundation found that two-thirds of Americans—including a majority of Republican voters—favor maintaining pre-existing conditions and essential health benefits. If the ruling stands and those provisions also are eliminated, it may be uncomfortable for Republicans, especially if (as seems likely) it occurs shortly before the 2020 elections.
We need more alcohol and drug rehab treatment centers, enough treatment for every person with a substance use disorder (SUD). If insurance companies are allowed to deny coverage to people with pre-existing conditions and mental health or SUD, those people will be less likely to afford or receive any help, let alone the dual diagnosis treatment (mental health and SUD) they may need.
Congress, the president, and the insurance companies need to make substance use disorder treatment centers more available and affordable or the problem will get worse.
