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TrumpCare: Does The Repealing of ObamaCare Change Addiction Treatment Insurance Coverage?

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 27, 2019

Treatment for addiction can be very costly for those who do not have insurance or their insurance does not cover addiction treatment. Learn how the repealing of the Affordable Care Act could affect the millions of Americans struggling with addiction and how to get the treatment you may need.

Addiction affects millions of people in the United States, and treatment can be costly— especially without a health insurance plan that covers mental health as an essential treatment. The American Health Care Act would leave the majority of the policies from the Affordable Care Act in place; however, Medicaid would likely take a blow from this repeal.

Except for maybe regular check-ups and physicals, most of us don’t expect to need a doctor’s care. None of us plan to get sick or have an accident when we sign up for health insurance. Nonetheless, it’s important to have, because when these things come up, we want to be treated promptly with the best healthcare available. Without health insurance coverage, we can be left with a hefty medical bill which can sometimes cost as much as, if not more than, a four-year college education.

How Does Health Insurance Help Pay The Bills?

Paying for addiction treatment hasn’t always been considered a necessity by state, and federal insurance programs, and paying for addiction treatment out-of-pocket can quickly build up to thousands of dollars. So the dilemma that could potentially occur here is that if mental health coverage is no longer mandated as a necessity, people suffering from mental health problems (such as addiction) could lose some of their insurance benefits. Having health insurance is sometimes necessary to get the quality and duration of care that is required for recovery from drug and alcohol addiction.

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What Is Addiction Treatment?

By itself, addiction treatment is a fairly broad topic—categorized as a mental health issue, it can refer to a myriad of treatments and therapy methods:

Addiction treatment is defined by the National Institute on Drug Abuse as being “intended to help addicted individuals stop compulsive drug seeking and use. Treatment can occur in a variety of settings, take many different forms, and last for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient.”

Can A Person Be Turned Away For Previous Mental Health Conditions?

As it is today, people will not be denied coverage by the Health Insurance Marketplace for pre-existing mental health conditions. Something called parity has been put into place to ensure that this doesn’t happen. Basically, what that means is everyone will be treated the same, and even though the Blue Cross Blue Shield application asks if a person smokes, or currently receives mental health treatment, this is not a valid reason for them to turn you away.

So Will Repealing The Affordable Care Act Change Addiction Treatment Coverage?

To answer the original question: Addiction treatment insurance coverage could possibly change with the repealing of the Affordable Care Act, but not for everybody. As it stands, those with private insurance will keep their essential health care benefit coverage (which includes addiction treatment) however, as stated below, the state Medicaid guidelines could change.

What Are The Addiction Treatment Benefits of ObamaCare?

According to the U.S. Department of Health and Human Services, “The Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services.”

Currently, all mental health care and behavioral health treatment is considered to be essential, and all plans are required to cover:

  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder (commonly known as substance abuse) treatment

Furthermore, in light of pre-existing mental health disorders and addiction:

  • Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
  • Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
  • Marketplace plans can’t put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services.
    (U.S. Department of Health and Human Services)

What Changes Should I Expect From The American Health Care Act?

The bill for the American Health Care Act would not only take away limits for the amount of money an individual can have in their health saving account (HSA), but it would also eliminate the penalty of being uninsured. This proposed act, as it stands, will not change mental care coverage for private insurance—although Medicaid, which is for individuals with low income, could take a hit. The American Health Care Act would give states more freedom to decide what conditions to cover.

Clearing Up Any Confusion About Trump Care

There’s a lot of confusion about the American Health Care Act (TrumpCare), and what it will do to affordable health care—according to the Washington Post “The Republican proposal to replace the Affordable Care Act would strip away what advocates say is essential coverage for drug addiction treatment.” In opposition, from the same source, “Republicans on the committee argue that the change would give states additional flexibility in coverage decisions, and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed.”

Furthermore, according to USA Today: “The bill keeps the essential health benefits requirement under the Affordable Care Act. Insurance companies would still have to cover 10 health services, including maternity coverage, prescription drugs and mental health care. State Medicaid plans, however, would not have to meet this requirement after Dec. 31, 2019.”

How To Learn More About Addiction Treatment

The war on addiction and substance abuse continues, and as President Trump stated to congress, “We will stop the drugs from pouring into our country and poisoning our youth,” he said, “and we will expand treatment for those who have become so badly addicted.”

Addiction is a serious problem in the United States, and 23.5 million people needed treatment for addiction in 2009, and as long as there are mood altering substances, there will be problems with addiction— recovery starts with a decision to get help… Contact Us today if you’re seeking help, or have questions about addiction treatment.

National Institute On Drug Abuse - Treatment Statistics

National Institute On Drug Abuse - Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

USA Today - Q&A: The facts on the Republican health care bill

Washington Post - GOP Healthcare Bill - Health Insurance and Mental Health Services

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