Building on the ACA to Address Substance Use Disorders & Mental Illness
The Affordable Care Act (ACA), 12 years old this week, achieved landmark advances in access to treatment for addiction and mental illness in this country. Thanks to the ACA, 31 million people have gained health insurance, and millions of people with substance use disorders and mental illness are able to get life-saving care. The ACA required most insurance plans to cover these behavioral health services as essential health benefits, and do so in a way that is equitable to other medical services. Children can stay on their parents’ health insurance plan until age 26, making it easier for young people to access addiction treatment and mental health counseling. The ACA also fostered integration of services for substance use and mental illness with other health care through Medicaid health homes, community health centers and other settings that provide the comprehensive services needed to achieve and maintain recovery.
Yet the statistics remain alarming. More than 40 million people in the US have a substance use disorder. Drug overdose deaths have reached an all-time high, topping 100,000 in 2021, and COVID-19 has worsened the crisis in every state across the country. Youth overdose deaths and suicide have been on the rise for years, both increasing by nearly 60 percent in the last decade, and emerging data suggest the pandemic has made things worse. Pediatric mental health and substance use disorders claims rose nationally for 13-18-year-olds as COVID disrupted access to services, reduced positive social connections, and eliminated protective factors that alleviate consequences of toxic stress and trauma. COVID is also taking a dangerous toll on health providers’ mental health as the workforce — already stretched thin and suffering from burnout— faces growing rates of post-traumatic stress disorder, depression, anxiety, and suicidal thoughts.
Fortunately, policymakers are paying attention and we have an opportunity to significantly build on the ACA. With the newly unveiled commitments from the White House to focus on addressing addiction and improving mental health, multiple congressional hearings in the Committees on Finance;Health, Education, Labor, and Pensions, and Ways and Means, and the Substance Abuse and Mental Health Services Administration’s (SAMHSA) unprecedented harm reduction grant program — improving access to services and supports for substance use disorders and mental illness is top of mind.
Community Catalyst supports these additional efforts to save more lives and help people lead healthy lives in recovery:
Expanding Medicaid in the 12 states that have still refused to do so, and supporting efforts to coordinate access to and expand coverage for substance use disorders and mental health services. People of color remain disproportionally without insurance in states that have not expanded Medicaid, and people of color face more barriers to accessing substance use disorders treatment than their white counterparts. Implementing Medicaid expansion in all states will help narrow racial inequities in health coverage and remove a significant barrier to treatment, services and recovery.
Requiring insurance coverage of coordinated crisis services and building on the bipartisan Behavioral Health Crisis Services Expansion Act.
Treating addiction as a health issue instead of criminal one by ending the War on Drugs that arrests and imprisons Black and brown people who use substances. We need sweeping public health investments such as those in the Comprehensive Addiction Resources Emergency Actprioritizing community-driven and community-based services.
Providing wrap-around services in schools including substance use prevention and early intervention programs, rather than punishment, for students who use or possess substances.
Increasing access to all life-saving harm reduction services by building on the SAMHSA harm reduction grant program.
Removing barriers to treatment for opioid use disorder by fully eliminating the “X-waiver” requirement through the bipartisan Mainstreaming Addiction Treatment (MAT) Act. This will help save lives, especially among communities of color where treatment disparities exist.
Allowing states to provide Medicaid coverage during the 30 days before individuals are released from incarceration through the bipartisan Medicaid Reentry Act (MRA). People reentering the community are 129 times more likely to die of an overdose than the general population; the MRA would make it easier for people to access the care they need, improve health outcomes and promote health equity.
As we celebrate the 12th anniversary of the ACA, let’s act now to build a more equitable, accessible and comprehensive system of services and supports for substance use disorders and mental illness.