How Changes in Healthcare May Impact Addiction Community

Group therapy session with therapist and client in foreground

Congress is working to repeal the Affordable Care Act (ACA) that was formulated under President Obama. Those individuals who struggle with mental health and addiction are most likely the ones who will be affected with the appeal.

Nearly 30% of those who are covered by the Medicaid expansion, have a mental disorder such as anxiety and schizophrenia, or an addiction to substances such as opioids or alcohol [1].

Those who support the ACA refer to the 20 million previously uninsured Americans who have health insurance with Obamacare. The ACA also creates a law that protects millions of Americans, from pre-existing medical conditions, ends lifetime caps on insurance coverage, and allows children to remain on their parents policies until age 26.

Those who do not support Obamacare say the ACA is not sustainable and it is collapsing under its own weight, that premiums are increasing, and the quality of healthcare is suffering nationwide [2].

The American Health Care Act, which is the act hoping to replace the ACA and deals with health care broadly, and will impact access to drug addiction treatment, and potentially how accessible health care is for those with drug and substance use disorders.

The Congressional Budget Office has estimated that the Republican bill would leave 14 million fewer people without health insurance by next year compared to current law, and the number would increase to 24 million by 2026 [4]. This could be devastating to millions of Americans.

Teamwork. Hands shakingAn analysis by Harvard Medical School and New York University researchers reported that Obamacare expanded access to care for 2.8 million Americans with drug use disorders [4].

Depending on how deep the repeal bill will be, that could mean millions of individuals with addictions could be left without health care or treatment options. How will those suffering from prescription drug addictions to oxycodone, hydrocodone, oxycontin, and the like be able to find the addiction treatment they need?

The new bill will begin to phase out Obamacare’s Medicaid expansion [4]. Under the ACA, the government pays for about 90% of the cost for states expanding Medicaid to cover anyone up to 138% of the federal poverty level.

The bill, which is sponsored by the House, will help keep the ACA in place, but enrollment will halt in 2020.  This could mean that with this new bill, states could be slowly taken off the Medicaid expansion. There are positives though. The proposed bill does retain some of the ACA provisions that benefit people with addiction.

It does prohibit commercial plans from excluding individuals who have a pre-existing condition. These exclusions previously prevented many individuals from gaining insurance because addiction was considered a pre-existing condition. Some commercial plans will be still be required to cover addiction benefits.

The current law requires insurers to provide equal coverage for addiction and medical conditions, or otherwise known as the parity law, which predates the ACA and remain in place for many of the plans. With the new plan, individuals will also be able to stay on their parent’s health plan until the age of 26.

What Could Happen if the New Bill is Passed?

The new proposed bill will fundamentally change the way the ACA increased the number of people covered by commercial insurance and Medicaid [5]. The changes could result in 24 million people becoming uninsured, essentially erasing the ACA’s coverage gains.

Struggling with an addiction and being uninsured can be problematic. Many individuals do not seek treatment for an addiction is due to lack of financial resources and lack of health care coverage. Without insurance, people are likely to forego preventive care which includes important screening, education, and brief intervention for substance use.

The ACA required coverage for addiction benefits for some insurance carriers, and the new bill will remove this requirement for Medicaid plans. It would require some commercial plans to cover addiction treatment. Without a requirement for benefits, plans could revert to prior discriminatory coverage if the new bill is passed.

The proposal would roll back the Medicaid expansion which would affect many states that have opiate crises, including Ohio, Kentucky and West Virginia. Nearly 30% of those who get coverage through the Medicaid expansion have a mental disorder, such as anxiety, depression, psychosis and addictions according to the Substance Abuse and Mental Health Services Administration [1].

That equates to 20% of the overall population who experience a diagnosable mental health or substance abuse disorder. Even if Congress approves a partial appeal in the future, it would eliminate tax credits which reduces premiums of 85% of those who buy insurance on the federal and state exchanges.
This allows those with tax credits to pay less than $100 a month for insurance and have significantly lower out-of-pocket expenses that make it possible for individuals to afford quality services.

Repealing the ACA would cost several states coverage for individuals struggling with addictions. In New Hampshire, 120,000 residents would lose coverage and federal data shows a near 200% increase in overdose deaths in the last five years.

In Ohio, there was a significant increase in men seeking help after Medicaid was expanded to all adults under 138% of the federal poverty level. Overdose deaths have climbed 20% in a 1 year period. In Kentucky overdose deaths went up 17% in a one year period according to the Kentucky Office of Drug Control Policy [1].

In Chicago one county jail has seen a 30% rise in inmates who are diagnosed with a mental illness. They have seen the ACA provide access to services and addiction treatment for inmates, where there was no help available prior to the ACA.

If the ACA is repealed, it would cause a significant amount of Americans to be without insurance and a lack of ability to pay for insurance. Since 2014, substance abuse treatment was considered one of the 10 essential elements of excellent health care and the ACA included drug rehab in all the health insurance packages sold on the Health insurance Exchange and Medicaid.

Beginning in 2020, the proposed plan would eliminate the ACA requirement that Medicaid cover basic mental health and addiction services in states that expand it, allowing them to decide whether to include those benefits in Medicaid plans.

In conclusion, the proposed health care act would significantly reduce the treatment availability to those current on the expanded Medicaid coverage through the ACA.

It would allow for insurance companies to revert back to prior standards of operation, and setting non standardized limits on healthcare services provided. Even with some of the ACA remaining in place, the accessibility to services will be limited to the addiction community.


Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.



The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on April 21, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on April 21, 2017.
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About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.