ACA Repeal: So Much to Lose for People with Substance Use Disorders
This blog is part of a series to highlight the dangers of repealing the Affordable Care Act. Multiple times a week, Community Catalyst will highlight a different constituency to draw attention to the benefits the ACA has afforded them and to outline what a loss of coverage would mean.
Given the devastating toll the opioid epidemic is having on our communities, the promise from congressional Republicans and President-elect Trump to repeal the Affordable Care Act would hardly Make America Great Again. Repeal would gut programs that provide prevention and treatment of substance use disorders. The costs in dollars and lives would be, to put it lightly, HUGE!
The Affordable Care Act (ACA) has literally been a lifesaver for people with substance use disorders:
- Through the ACA’s “Essential Health Benefits” requirement, approximately 20 million people have access to coverage for substance use disorders and mental illness. People newly enrolled in either Medicaid or private insurance obtained through the ACA marketplaces are guaranteed coverage of substance use disorders for the first time. A rollback of the ACA could eliminate all coverage for millions of people and weaken or eliminate the requirement to treat substance use disorders.
- Recovery from addiction often takes more than one try. Through the ACA prohibition on insurers denying coverage for pre-existing conditions, people with substance use disorders are able to get insured even if they had a recurrence of symptoms. Repeal of the ACA could bring back the one strike and you’re out.
- Addiction often starts early – more than 15 percent of young adults age 18-25 have a substance use disorder. But repeal would eliminate the ACA provision allowing young people to access coverage under a parent’s insurance plan up to age 26 potentially leaving these young adults with no coverage at all.
- The ACA also expanded the Mental Health Parity and Addiction Equity Act to more Medicaid plans and all marketplace plans, which requires them to provide coverage for substance use disorders and mental illness that is no more restrictive than coverage for medical and surgical treatment. This protection would evaporate if the ACA is repealed, leaving many people with skimpy, if any, coverage.
Proposed changes to Medicaid financing could also deal a harsh blow to services addressing the problematic use of drugs and alcohol. Block granting and per capita caps – both being considered by congressional Republicans and Rep. Tom Price, the president’s nominee to oversee the federal Department of Health and Human Services, – would force states to do more with less. This could mean:
- Waitlists for services. Right now, Medicaid is guaranteed to anyone who is eligible.
- Cuts to services. With less money and no requirement to cover substance use services at parity, states could reduce or eliminate treatment.
- Co-pays and cost sharing increases. This is especially dangerous for vulnerable populations, including those with substance use disorders.
Even if they have insurance coverage, access to care remains a big barrier for people with substance use disorders. This is sometimes because of stigma but also due to a shortage of providers. The ACA has added or expanded services for substance use and mental illness in hundreds of health centers nationwide. The ACA also established the Health Home model in Medicaid for people with chronic conditions, including substance use disorders. This approach integrates behavioral health with primary care and much-needed family and community based supports.
The ACA also provides for all screening, including for substance use, at no cost to the consumer. Losing this provision would add another barrier to people getting care early before their substance misuse has progressed to costly addiction.
More than once, Candidate Trump asked the American people “What do you have to lose?” For people with substance use disorders, the answer is “too much.” Repealing the gains of the Affordable Care Act with no replacement plan would cause millions of vulnerable Americans to suffer “hugely.”