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The Affordable Care Act, Recovery & You

There has been much discussion about how the Affordable Care Act influences different sections of the medical profession as well as a patient’s ability to receive quality care. When it comes to those suffering from substance abuse, the ACA does affect insurance for individuals who need rehabilitative care for their addictions and other types of substance abuse disorders.

ACA improves access to addiction treatment for many.

ACA includes substance use disorders as one of the ten elements of essential health benefits.

What is the Affordable Care Act?

The Affordable Care Act (fully titled the Patient Protection and Affordable Care Act) is a federal law that was signed March 23, 2010. The law was passed in order to make a change to the way the health care system in the United States is run. Its goals were to make health insurance easier and cheaper to obtain and to lower the amount of people who go uninsured every year. You can read the law in its entirety here.

Does the Affordable Care Act Influence Treatment Insurance?

Yes. The ACA affects all types of insurance, and individuals who are looking for rehabilitation for a substance abuse disorder should know the facts of the ACA. However, insurance is only one of a person’s concerns when entering rehab. People seeking rehab treatment also have to consider:

  • If they will choose inpatient or outpatient care
  • If they can take the necessary time away from their lives needed for rehab, especially when choosing inpatient treatment, and how their responsibilities will be taken care of in the meantime (ex. single parents might need to find someone to take care of their children for an extended period)
  • If they can afford a private facility or if they should seek less expensive facilities that work on a sliding scale payment plan
  • If they are truly committed to rehabilitation and getting better

How Does the Affordable Care Act Influence Addiction Treatment Coverage?

According to the ONDCP, “the ACA includes substance use disorders as one of the ten elements of essential health benefits,” meaning that new insurance sold in 2014 on Health Insurance Exchanges by law “must include services for substance use disorders.” This is also true for health insurance services provided by Medicaid.

These changes also mean that “more health care providers can offer and be reimbursed for these services,” so some individuals who had not previously had access to insurance for substance use disorders will have access to it now. The specifics of the types of services are still being decided, but it means many more people will have access to rehab insurance.

SAMHSA also states that “people living with mental health challenges or substance use disorders often have problems getting private health insurance. Now there are special insurance protections to help.” Because of the Affordable Care Act, more people will have access to insurance for their substance use disorders, whereas before, many people could not afford treatment because they could not afford insurance. While the Affordable Care Act is but “one aspect of a broader movement toward reforming the health care system,” it is the hope that now more people will seek and receive treatment for their substance use disorders which will be covered by their insurance providers because of the law.