The Affordable Care Act and You: How Obamacare Affects Your Access to Treatment

Service providers at drug and alcohol treatment centers are excited about the opportunities spelled out in the Affordable Care Act (ACA) that will hopefully expand the availability and scope of addiction treatment. Mental health and substance abuse services generally fall under the category of behavioral health. While many insurance companies have refused to provide adequate coverage for such care, implementation of the ACA may change all that.

The truth is that 8.9 million American adults not only suffer from substance abuse but also experience co-occurring disorders. What that means is that some type of mental health illness is going in conjunction with the person’s medical diagnosis of addiction. For example, if someone with bipolar disorder cannot or does not get mental health treatment, he might self-medicate with illegal drugs to improve his symptoms, with an accompanying risk of addiction.

Many people who abuse drugs experience profound physical disorders of some kind, either a long-term disease process or a physical disability. Quite often, the user will experience respiratory problems because he engages in poor health habits such as smoking cigarettes. Many complain of stomach disorders and dental problems associated with drug ingestion.

The converse of this scenario also applies: If someone falls into a pattern of habitual alcohol or drug use, he will begin to neglect his physical needs. He may no longer be able to afford his regular medications, whether they are for mental or physical health maintenance, because he spends his money on his substance of choice. He will neglect his nutrition and sleep requirements.

The Affordable Care Act offers hope that staff in drug and alcohol treatment centers will be able to provide a full cadre of services to the abuser, ensuring both his physical and mental health. Our figures need to improve, because right now less than 8 percent of those 8.9 million people are receiving both medical and mental health services.

The Substance Abuse and Mental Health Services Administration (SAMSHA) reports that an integrated approach to treatment ensures better outcomes with a higher percentage of patients staying healthy and remaining free of drugs. With the Affordable Care Act, more people will have the insurance to cover those benefits.

There is still a concern among many substance abuse treatment providers that private insurance companies will find loopholes to get out of paying for covered services. The federal Mental Health Parity Act passed in 2011 requires health insurance companies to subsidize services for mental health on the same level as medical or surgical benefits. The Affordable Care Act means that employer-provided health insurance plans must offer inpatient and outpatient benefits for substance abuse treatment.

In the case for residential treatment, however, managed care organizations typically process such requests with great reluctance. Usually the professional at the drug and alcohol treatment center who will be providing services must identify the substances abused by the addict as well as how they are taken and how often they are used. Additional factors such as risk-taking behaviors, social and family stressors, and suicidal tendencies are reviewed. Most often, even if there is a level of risk associated with undergoing treatment while the addict continues to live at home, the managed care provider will insist upon outpatient treatment.

Ultimately, the most significant aid to treatment that comes from the Affordable Care Act will be the integration of substance abuse treatment with services for co-occurring mental health and medical diagnoses. The drug and alcohol treatment centers that expand to provide services to treat the whole person will be the ones that remain viable as we head into the future.

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