While controversies and website problems have plagued the Affordable Care Act’s (more commonly referred to as Obamacare), many people with family members coping with substance abuse and mental health issues have pondered how the new Federal regulations affect them and their loved ones. People struggling with addiction, looking for help, have also been curious as to what this new program may offer them in the way of help kicking their drug and alcohol habit. Now that open enrollment in the government ACA website has ended, let us discuss what addicts and family members need to know, so they can take advantage of the next round of enrollment at an exchange or when purchasing private insurance outside one of the government sanctioned health exchanges.
Extended Recovery Assistance
When it comes to persons struggling with addiction, the ACA extends recovery assistance in four ways. First the ACA makes mental health coverage a mandatory component for new individual health insurance plans and small business plans. While the ACA mandate does not extend to the large corporate plans, it does provide a helping hand to single-person plans and people suffering with addiction who work for a small company.
Parity Between Types of Treatment
Additionally, the ACA law also demands parity between addiction and mental health coverage and traditional medical treatments. What does “parity” mean in the context of our discussion? Simply put, it means that insurance companies cannot charge you more for mental health or addiction coverage than they do for things like emergency room visits and doctors appointments, just because one is psychological and the other is physical. This may sound familiar to readers who recall the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) which sought to achieve the same goal, but left loopholes in which companies could simply drop all mental health coverage and avoid the additional expense of offering insurance to their employees.
Insurance Company Changes
The ACA also demands that insurance companies provide coverage for preexisting conditions. As the struggle with addiction begins early in life, often during the formative teenage years, this is good news for people who are struggling with addiction. Now a history of drug and alcohol abuse or psychological disorders like bipolar disorder, cannot be used as factors in denying coverage. Some may voice concern that premiums may rise, or have indeed risen, to compensate for this additional coverage. Others in our nation’s capital remind us that access and parity for co-pays and charges should make-up for any other change in expense.
Psychological Help Included
The new offer of psychological help for persons from all walks of life is also a well intentioned change to current rules and regulations. Mental health is not just for persons suffering from bipolar disorder or the more extreme cases of schizophrenia. Mental health treatment under the ACA applies to people who are just going through a tough emotional time and are in need of help. Every day people face the crisis of losing their jobs, going through divorces, custody battles and other life events that can plunge them into depression or a destructive spiral of self medicating, overusing alcohol and tobacco. The ACA seeks to help everyone from all walks of life, before they even know they need help.
As part of the implementation of this landmark process to show greater compassion for those suffering from addiction, the ACA has also made putting a stop to smoking tobacco a requirement for insurance providers. Those needing to kick the habit will be able to get the assistance they need, without need of a co-pay, via the government approved plans made available in the healthcare exchanges. Not all medications designed for use kicking the smoking habit will be covered by the program, but it is once again a great step in the right direction. It should, however, be noted that Medicaid will not offer treatments to help people stop smoking.
Young people also have the advantage of knowing they can remain on their parent’s insurance up until the age of 26. For the purpose of our discussion today, this goes hand-in-hand with new regulations regarding preexisting conditions. Now that young people can retain the health benefits they had as a child and teenager, it will be easier for them to seek help with their substance abuse problems and find treatment. This also could give parents a greater hand in the recovery process as the primary insurance holders.
What Else Does it Provide?
Finally, the ACA has measures designed to provide “Screening, Brief Intervention, and Referral to Treatment”, also known as SBIRT. This program run by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), has been structured to allow professionals to make early determinations of addiction regardless of an identified disorder, then compel treatment for people at risk of addiction before it becomes a diagnosable problem.
In an ongoing government effort to curtail drug and alcohol abuse, medical professionals who work in the employee of hospitals, clinics, primary care physicians and even employee assistance programs at a person’s work can now compel people to answer a three-question survey that indicates whether a person may already have or be developing an issue with addiction. If this first survey suggests there could be a problem, they can next compel someone to take a more detailed assessment, usually the AUDIT questioner or the ASSIST exam.
What If I Fail the Test?
Responses to either of these communications can lead to a “brief intervention”, usually consisting of a 30 minute discussion about addiction and the importance of personal responsibility. In some cases, these brief interventions can lead to an order for brief treatment that can last up to 12 one-hour sessions, or a referral to treatment. Local laws and agencies can become involved at this point and thus the degree of which someone may be compelled into treatment varies depending upon the state you live in. As an example, Florida’s Marchman Act provides the legal standing to involuntary commit someone to a treatment program.
In the end, all of these legal and financial measures are designed to provide preemptive tools meant to foster preventive care and save the taxpayers money. It lays down the policies that can compel needed screenings for possible addiction and mental health problems, and give care providers and employers the tools they need to initiate interventions into the lives of insurance policy holders. The program has only the best of intentions and it is just one more way the Affordable Care Act works to make people healthy and well.
How to Enroll
Enrollment into insurance can be complicated by the Affordable Care Act. Insurance companies and members of the government implementing the law expressed worry over persons waiting to sign-up for health insurance after an accident. Persons in the government also worried that insurance companies may harass people recently injured or in need of medical attention, pestering them to sign-up for coverage. To prevent this, personal and family insurance are no longer available all-year-round. While corporate and business plans can still be entered into when offered, plans an individual person may get for themselves or their family will only be available during designated “open enrollment” times throughout the year.
Exceptions to Open Enrollment Policy
As the government does understand that some people may have a life event that necessitates a change in insurance, there are some specific circumstances in which a person may still apply for coverage outside the approved open enrollment periods. Some qualifying life events include marriage, divorce, the birth of a child, termination from employment and a qualifying change in income, or the death of a spouse.
Why Should I Sign Up?
Signing up for insurance coverage during these time periods, particularly for those persons who currently do not have the protections offered by these services, is encouraged. Treatment centers, intensive outpatient programs and aftercare services are all supposed to be covered by insurance, no questions asked. Some delays in the implementation of specific ACA mandates made by President Obama to give states and corporations time to implement all the changes legally required by the ACA could limit or stall some services, so be sure to speak with your provider and primary care physician to make sure all your treatments are fully covered.
As with all new programs, there is going to be a period of growing pains. It is estimated that some 40 million people who have had no previous access to mental health or substance abuse treatment, may enter into assistance programs all over the country. With limited beds and space at existing rehabilitation clinics, this could have the effect of restricting some access to treatment. It is hoped that this will only be a temporary circumstance as more health providers become available to offer treatment. Please do not let these growing pains discourage you from seeking help for yourself, friends, or family.
A Brand New Approach
Remember, the Affordable Care Act is a whole new way of addressing insurance and patient care. It is the first step in tearing down an old system, and replacing it with something the government assures us will be better. Some of these changes may not translate into immediate results for everyone, but many in Washington D.C. believe that this is a good first step to providing greater access and more compassionate care for those suffering with addiction. It is something that could possible save everyone money, by finding people who do not currently addicts or suffering mental health issues, but may be susceptible to these ailment. We have a chance to find these people and help them before they plunge down the slippery slope of addiction.
Please Get Help!
If you are suffering form mental illness or addiction, remember that you are not alone. Your friends, your family, your loved ones and the Federal Government are all here to help you. Take the first step in getting well. We live in interesting times. Don’t miss your chance to be part of the revolution.
- COVID-19 Protocol – We’re Here for You - April 2, 2020
- Five Ways to Address the Holidays and Addiction Recovery - November 11, 2019
- Choosing a Therapist in Utah Who’s a Good Match for You - September 26, 2019