How will health-care reform affect addiction treatment?
Got questions about the Affordable Care Act? In a regular feature, the WHYY/NewsWorks Health and Science Desk is providing "The Short Answer."
Will addiction treatment be affected by the Affordable Care Act? It's expensive, and many insurance plans don't cover it.
The short answer
Yes – and some experts tell me – addiction treatment will be affected more than any other disease issue by this legislation.
Many insurance plans have either not covered addiction treatment at all or have covered it in a limited fashion. Cost has been a major barrier to accessing treatment -- rehab clinics can cost several thousand dollars a month.
Only about 10 percent of the 23 million Americans with alcohol or drug problems now receive treatment, according to the National Survey on Drug Use and Health.
Traditionally, addiction has been treated in a silo, it has not been part of regular health care, and people battling addiction have been treated by specialty clinics, rehabs. They were not treated until their addiction had spiraled out of control, until they "hit bottom."
How is the ACA supposed to change this?
Starting in 2014, health plans have to include "essential health benefits" and among them are mental health and substance use disorder services, including behavioral health treatment; rehabilitative services and devices; wellness services; and chronic disease management.
Will more people have access to treatment?
Since insurance companies have to cover treatment for addiction, the thinking is that more people will access treatment, as cost has always been a barrier to getting care.
More people will have health insurance.
Since doctors can now bill for preventive services and chronic disease management, some parts of addiction prevention and treatment could move into the realm of primary care. When a doctor asks a patient about his drinking habits or her possible drug abuse, and there are red flags, they might do some short-term treatments right there in the office. The hope is to catch issues earlier, before they have spiraled out of control.
Didn't the Parity Act cover all this in 2009?
The 2009 Mental Health Parity and Addiction Equality Act basically mandates treating mental health issues with same range of benefits as illness of general medicine. It says, in essence, if you cover addiction treatment at all, you have to cover it the same way. But a lot of insurance companies didn't cover addiction treatment, so they didn't have to change anything. One expert I spoke with said that the Affordable Care Act gives the Parity Act teeth.
One big questions is how much the added benefits will affect the cost of insurance. Another question is how quickly the health-care system will embrace a more preventive approach to addiction, and whether there are enough addiction treatment professionals and facilities to accommodate the additional patients who may be seeking treatment.