Director of the Health Integration Project
Repealing the Affordable Care Act (ACA) would eliminate access to behavioral health treatment for several million people with serious mental illness or substance use disorders, including opioid addiction, our new paper explains.
In fact, health care economists Richard G. Frank and Sherry A. Glied estimate that repeal would put 2.8 million people with substance use disorders — including 220,000 with opioid disorders — at risk of losing their health coverage, including coverage of addiction treatment.
Expanding access to needed treatment for people battling addiction issues has been an important but little-publicized accomplishment of the ACA. Before the ACA, most people needing addiction services couldn’t afford them because health plans routinely didn’t include substance use treatment or severely limited what they covered and for how long. The ACA’s expansion of Medicaid to adults with incomes up to 138 percent of the poverty line allowed more people with substance use disorders to qualify for Medicaid.
Also, strengthened benefit requirements and consumer protections — protections that started with the 2008 Mental Health Parity and Addiction Equity Act — expanded access to addiction services. These protections prevent health plans from imposing annual or lifetime benefit limits for behavioral health services, requiring higher co-pays for behavioral health services, or imposing more restrictive caps on the number of behavioral health treatment visits than on similar physical health treatment visits, among other things.
In the few years since the ACA’s coverage expansions took effect, we’ve seen results. In states that expanded Medicaid, the share of people with substance use or mental health disorders who were hospitalized but uninsured fell from about 20 percent in 2013 to 5 percent by mid-2015, a recent Department of Health and Human Services report found.
The Medicaid expansion has been particularly beneficial in states hit hardest by the opioid epidemic. In West Virginia, the state with the highest drug overdose death rate in 2015, the share of people with substance use or mental health disorders who were hospitalized but uninsured fell from 23 percent in 2013 to 5 percent in 2014.
For substance use treatment, the negative impact of ACA repeal also would more than offset the gains stemming from the 21st Century Cures Act, which Congress passed in 2016 with bipartisan support. The Cures Act, coupled with the 2016 Comprehensive Addiction and Recovery Act, provides new grant funding for mental health and substance use treatment providers to implement evidence-based care. However, as we’ve explained, Cures Act funding alone is far from sufficient.
Researchers Frank and Glied estimate that ACA repeal would cut substance use treatment spending by $5.5 billion annually, while the Cures Act only provides $1 billion over the next two years. Repealing the ACA would take the United States backwards by limiting access to substance use treatment services at a time when they’re desperately needed.