The Affordable Care Act: Addiction Coverage

April 7, 2015

The Affordable Care Act: Addiction Coverage

Prior to 2013, over 47 million Americans were without health insurance coverage, and 25% of those had either a mental health condition or a substance abuse disorder…or both. These are striking, frightening figures, and this has finally led to the U.S. Government passing the Affordable Care Act in 2013, effectively covering a large amount of people who otherwise would not be covered; many of these now have coverage for substance abuse disorders and mental health issues.

 

What does The Affordable Care Act do?

The Affordable Care Act supplied one the greatest increases of mental health and substance abuse disorder treatment in a generation. Starting in 2014, under this law, all contemporary small group and exclusive market policies will be obliged to cover 10 Essential Health Benefit categories  these consisting of mental health and substance abuse disorder services, and will be required to cover them and parity (equity)  with medical and surgical remuneration. The Affordable Care Act expands the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which mandated group health plans and insurers that provide mental health and substance abuse disorder benefits to offer coverage that is identical to coverage for standard medical and surgical care.

While almost all large group plans and most small group plans provide coverage for a number of mental health and substance use disorder services, there is a large disparity in coverage and some with some coverage, and these services did not  have the advantage of federal parity protections.   The concluding statute putting into process the Essential Health Benefits orders non-grandfathered health plans in the individual and small group markets to cover mental health and substance use disorder services, in addition to conform to the federal parity law requirements, starting in 2014.

 

Pre-2014 Coverage

About a third of the people currently included in the particular market were without coverage for substance use disorder services and almost 20% were without  coverage for mental health services, including outpatient therapy office or clinic appointments and inpatient crisis intervention and stabilization. Plus, even when individual market polices provide these benefits, the federal parity law doesn’t apply to this coverage to guarantee that coverage for mental health and substance use disorder services are generally equivalent to treatment for medical and surgical care.

In the small group market, coverage of mental health and substance use disorder treatment is more universal than in the individual market.   Approximately 95 % of those with small group market coverage have substance abuse and mental health benefits.  Again, the federal parity (equity)  law is not applicable to small group plans.  In several states, state parity laws make available those covered in this market an amount of parity protection, but most state parity laws are smaller than the federal parity requirement.

To reiterate, 47.5 million Americans lack health insurance coverage altogether, and 25 percent of uninsured adults have a mental health condition or substance use disorder or both.

 

Increased coverage for substance abuse

The Affordable Care Act and its applied policy, strengthening the Mental Health Parity and Addiction Equity Act,  increases coverage of mental health and substance use disorder benefits and federal parity protections in three specific  ways:  (1) by incorporating mental health and substance use disorder benefits in the Essential Health Benefits; (2) by employing federal parity security to mental health and substance use disorder benefits in both the individual and small group markets; and (3) by allowing more Americans to receive more appropriate and higher quality health care that includes greater coverage (than pre-2014)  for mental health and substance use disorder services.

 

Essential Health Benefits

To begin with, under this  statute, treatment for mental health and substance use disorders is a benefit type covered as a component of the package of Essential Health Benefits presented to all Americans in non-grandfathered plans in the individual and small group markets as of January 1, 2014.  The Essential Health Benefits ending rule ensures that those obtaining insurance can be assured  that their health plan will offer the care they need if they are in need.  Including mental health and substance use disorder treatment in this package means that nearly 4 million people currently protected in this particular market will receive  either mental health or substance use disorder coverage or both;

It is also projected that over 1 million people now enrolled in small group plans will receive mental health and substance use disorder benefits under the Affordable Care Act.

 

Access to Quality Health Care

Affordable Care Act will increase insurance coverage to approximately 27 million previously uninsured Americans through admission to private health insurance in the individual and small group markets, in addition to Medicaid. Essential Health Benefits, including mental health and substance abuse disorder services subject to parity (equity) provisions, are  available to the current populous.

In total, through the Affordable Care Act, 32.1 million Americans will now have available coverage that comprises  mental health and/or substance use disorder benefits that act in accordance with federal parity requirements plus more than  3o million Americans who now have some mental health and substance abuse benefits will benefit from the federal parity security.  By assembling the structure of the Mental Health Parity and Addiction Equity Act, the Affordable Care Act will extend federal parity protections to 62 million Americans.

Addiction, Treatment
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