What Does The Obamacare Repeal Mean For Addiction Treatment?

Two laws presently make it possible for anybody in America to obtain an insurance policy that will help cover the costs of treatment for addiction.

  1. The Mental Health Parity and Addiction Equity Act of 2008
  2. The Affordable Care Act

The Mental Health Parity and Addiction Equity Act of 2008 mandates that if insurance companies cover addiction treatment - i.e. acute detox, subacute detox, residential inpatient, partial hospitalization, intensive outpatient, and outpatient programs - that they cannot put any limitations or restrictions on that coverage that are inconsistent with the rest of the plan. Meaning, if you have a $5,000 deductible, your plan cannot have an arbitrary $20,000 deductible for mental and behavioral health benefits.

If your plan offers coverage for addiction treatment, it may not apply any limitations to that coverage that it does not also apply to all other treatments covered by the plan.

However, while the Mental Health Parity and Addiction Equity Act of 2008 has done wonders for making addiction treatment a possibility for millions of Americans, there is one critical element that the law does not possess: a mandate that insurance companies cover addiction treatment to begin with. An insurance policy only needs to have “mental health parity” if it offers mental health coverage, but an insurance company is free to simply not offer coverage for addiction treatment and still be in compliance with the Mental Health Parity and Addiction Equity Act of 2008.

The mandate that all insurance policies cover mental/behavioral health and addiction treatment exists solely in the Affordable Care Act. So if the ACA is repealed, the mandate that rehab or addiction treatment of any kind is covered by one’s health plan goes away.

And if that mandate goes away, in all likelihood, 90% of insurance policies in the United States will stop covering addiction treatment - as it is quite expensive.

Given, over a long enough time period, it is cheaper for insurance companies to cover addiction treatment than to pay for all of the long-term health effects of untreated addiction, like heart disease, ER visits, and a myriad of other things, in the short term, it is cheaper to simply not cover addiction treatment.

And the reason why, if the Affordable Care Act were repealed, insurance companies would stop offering addiction treatment coverage is simple: most people do not stay with the same insurance plan for decades. And it is only over a span of decades that the investment of $20,000 to $100,000 to put an individual through a comprehensive treatment program actually pays off.

Thus, if the average person only stays with the same insurance plan for say 1-5 years, then their insurance company will not bear the cost of their long term medical care resultant from untreated drug addiction - and hence, the insurance company has no interest in covering addiction treatment.

If the Affordable Care Act is repealed and is not replaced by another law that has a similar mandate, mainstream access to high quality addiction treatment will disappear - at least until innovation brings the cost of care down.

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