Office of National Drug Control Policy

The New Healthcare Reform Law: Helping to Close The ‘Treatment Gap’

The Affordable Care Act, signed into law by President Obama in March 2010, improves coverage for and access to health care for mental illness and substance abuse disorders. Under the new law, services such as screening, early intervention, treatment, and recovery support for patients with substance abuse disorders will be provided in the same manner and in the same, primary care settings as services for diabetes, asthma, or any other illness. The change will bring needed help to many as it also increases awareness that drug dependence is a chronic, treatable disease.

In 2008, 23.1 million Americans age 12 and older needed treatment for a substance abuse problem, and yet only 2.3 million – one in ten – received care at a specialty treatment center. Many of those who do not receive, but could benefit from, treatment do not have health insurance or other means to pay for it. By helping more people get the care they need, the new law will go a long way toward closing the “treatment gap.”

Features of the healthcare law that will benefit those in need of treatment for substance abuse problems include:

Broader Coverage for Americans with Substance Abuse Disorders

  • Of the 32 million currently uninsured Americans who will receive health insurance under the new law, about 5 million meet medical diagnostic criteria for a substance abuse disorder.
  • These Americans will receive insurance coverage to help pay for substance abuse treatment.
  • Along with other steps the Administration is taking, this broader coverage could double the number of people who receive treatment.
  • With improved coverage for Screening, Brief Intervention, Referral, and Treatment (SBIRT) in primary care, more Americans will be screened for substance abuse problems and given the care they need.

No Denial of Coverage for Pre‐Existing Conditions

Insurers will no longer be able to deny coverage based on pre‐existing medical conditions, such as substance abuse disorders.

Plans Must Cover Substance Abuse Disorders

  • The law requires a basic benefit package for all health plans in the individual and small group health exchanges.
  • All such plans will be required to cover mental health and substance abuse disorder services and to ensure benefits meet the “parity” requirements of the Wellstone‐Domenici Mental Health Parity Act of 2008. (The Act prohibits plans from covering mental health and substance abuse disorders at levels lower than their coverage for other illnesses.)

Greater Access to Treatment through Medicaid

  • In 2014, Medicaid eligibility will be expanded for families or individuals with incomes up to 133 percent of Federal poverty guidelines.
  • Many newly eligible beneficiaries will receive substance abuse and mental health services.
  • Participation in Medicaid will help more patients gain access to traditional healthcare benefits, such as medications and behavioral therapies in the treatment of addiction.

More Funding Requested for Prevention, Treatment, and Law Enforcement

Overall, the Administration’s FY 2012 Budget proposal would increase funding for prevention programs by 7.9 percent and treatment programs by 1.1 percent over the FY 2010 enacted level. It also would strengthen law enforcement programs, many of which address substance abuse among Americans in corrections and criminal justice programs.

Extended Coverage Under Parents’ Health Plans

  • Young people up to age 26 – a population with a significant incidence of substance abuse disorders – who do not have their own health insurance can obtain coverage under their parents’ plans. Previously, health insurance for dependents in many states ended at age 19 or upon graduation from college.

Substance Abuse Disorders Listed as Priority

  • The Affordable Care Act establishes a National Prevention Council, led by the Surgeon General, with substance abuse disorders as a national priority for the Council’s report to Congress. The Director of the Office of National Drug Control Policy will serve as a member of the Council.
  • Mental health and behavioral health are listed as high priority areas in the new law’s National Workforce Commission section.

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