Several years ago, our nation set out on a journey to reform medical care and insurance. The Affordable Care Act (ACA), also known as Obamacare, promised to provide better coverage at better prices. As part of the ACA, insurance companies were expected to provide coverage for Addiction Treatment. The current administration under President Trump has begun to make some changes to the requirements of the ACA. Opinions remain divided regarding the impact of the new administration’s changes to healthcare coverage. Some assert that these changes will undermine current progress in providing treatment for substance abuse, while others disagree.
The Mental Health Parity and Addiction Equity Act of 2008 requires both public and private insurers to cover mental and behavioral services equally with other medical conditions. The Affordable Care Act (ACA) declared these services to be an essential benefit for insurance companies to cover. All approved plans must include coverage for behavioral health treatment, including addiction rehab services and substance use disorder treatment. This coverage must begin the day your insurance coverage starts even for pre-existing conditions. Plans cannot impose yearly or lifetime dollar limits on such coverage.
President Trump has declared that the opioid crisis is a public health emergency. Of the approximately 20 million adults suffering from substance abuse, less than 12% are receiving treatment. Critics of the declaration point out that the US Congress is proposing significant cuts to Medicare funding and that one of President Trump’s executive orders allows some healthcare plans to ignore the health parity mandate. Critics also point out that the declaration does not offer any increased funding for addiction treatment.
The 21st Century Cures Act, passed in December of 2017, provides one billion dollars over the next two years to expand addiction treatment across the nation. President Trump has declared additional funding to research pain relief medications that are not addictive and has pledged to suspend a rule that prohibits Medicaid from funding many addiction treatment facilities. Since many cases of addiction begin with prescriptions for pain relief medication, non-addictive pain medications would be a very valuable resource. Nonetheless, many leaders of the addiction treatment industry declare that increased funding is necessary to respond to the opioid abuse problem.
Trump has also stated an intention to limit the quantity of opioids that are brought into the country. As part of this effort is a pledge to eliminate loopholes that permit China to ship fentanyl into the country. Fentanyl is a type of opioid that is often recognized as dangerous and is responsible for many deaths resulting from opioid overdose. However, access to naloxone, a drug important to the treatment of opioid addiction will be increased.
Unfortunately, President Trump has also decided to stop making the scheduled payments to insurance companies (known as cost sharing reduction payments) that help them lower deductibles for low-income customers. This action doesn’t repeal the ACA or alter any of its provisions, but the cut in payments will likely lead to significantly higher premiums for customers as the insurance companies struggle to recover the lost federal payments. An executive order also instructs the Labor Department to modify guidelines that prevent small companies from banding together in order to get the same kind of insurance coverage that large businesses are able to get. Such plans would be governed by federal employment rules rather than state insurance rules, giving them more leeway about benefits. This may result in state insurance regulators having trouble raising the money needed to guarantee that these insurers have sufficient funds to pay the medical bills of their members. The Center for Medicare and Medicade Innovation has also committed to grant states more waivers to test alternative ways of providing healthcare to their residents. These are regulatory changes, not changes to the ACA. Any changes to the ACA would have to go through Congress.
Views on the future of treatment for addiction seem to depend upon where a person stands on the political spectrum. For those on the left, it seems that vast amounts of increased funding are needed. For those on the right, it seems that current funding is too high. In reality, many of the provisions of the 21st Century Cure Act will be in the hands of bureaucrats and other leaders. There is no firm guidance yet on how things will turn out, especially since the Act was passed only a couple months ago. In the meantime, it will be up to concerned community leaders to make a good faith effort to do the most good with what is available.
Trump’s declaration that opioid abuse and addiction are a national health crisis is definitely a step in the right direction. How that declaration will impact public policy and funding for addiction treatment is not yet known. The ACA remains the law, so the protections and provisions of the law remain in place, at least until Congress makes changes, if they choose to do so.
The opioid crisis is not going to get better on its own. Insurance companies, treatment facilities and government entities will each play a role in shaping the future of addiction treatment. Surrendering the questions to political concerns isn’t going to help. Continuing criticism of what is being done without proposing something better isn’t going to help either. More preferable is for all concerned parties to work together openly and honestly to accomplish the most good possible.
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