The mental health profession needs to be prepared for potential large-scale changes.
[Editor’s Note: This article was contributed by Constance (Ahuva Batya) Scharff, PhD. Dr. Scharff serves as Senior Addiction Research Fellow and Director of Addiction Research for Cliffside Malibu.]
What changes will be made to the Affordable Care Act and other healthcare systems under the Trump administration? Those of us in addiction and mental health treatment are concerned that access to care overall will be diminished, but hold out hope that bipartisan support to address the opioid overdose epidemic will continue.
General Healthcare Reforms
One of the changes Donald Trump called for in his campaign was for the immediate repeal of the Affordable Care Act (ACA), often called “Obamacare.” Just days before the election, Trump even asked Congress to convene a special session to repeal the ACA. Without a plan to replace the ACA, its repeal could have potentially left millions of people without medical insurance.
Since becoming president-elect, Trump has pulled away from his call immediately to repeal the ACA and is now looking at how the plan will be replaced. Trump’s website states, “We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country.” Unfortunately, these free market principles are precisely what could keep access to critical care from millions of Americans.
What’s Important Under the Affordable Care Act
There is no doubt that the ACA has some tremendous flaws, most notable of which are the high premiums many pay for their policies. There is no question that we need healthcare reform.
Trump has indicated that key principles of the ACA may be retained. Doing so would help with a seamless transition to the new system, whatever it may be. There are five key principles that should be retained in the new health insurance system, though it is unknown whether all these points will be kept. Each pushes up the cost of care by increasing access to care for those who are ill or could become ill.
- No return to pre-existing condition limitations.
- Allow young people up to the age of 26 to stay on their parents’ insurance policy.
- No return to lifetime limits on coverage.
- No return to different pricing for men and women.
- Retain mental health and addiction coverage parity.
These rules put limitations on insurance companies about whom they can leave out of the insurance system. Insurance companies work to maximize profit while paying out as little as possible. Regulations like those listed above maximize access to care at the expense of profit.
What is important about the ACA is not just that it provides health insurance coverage for millions of people, but it also makes it possible for many people, who overcame cancer or required care of an ill child, to be insured.
The Importance of Mental Health and Addiction Treatment Parity
In addition to the ACA, we need to address the ways in which the Mental Health Parity and Addiction Equity Act (MHPAEA) will be integrated into any new legislation. According to the Centers for Medicare and Medicaid Services, “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.” Retaining the MHPAEA will ensure that those in need of mental health services and addiction treatment will have access to care.
Mental health and addiction treatment parity is critical to making addiction treatment accessible. Addicts are not a population that often has the funds to self-pay for quality addiction treatment.
Trump has spoken positively of the Comprehensive Addiction and Recovery Act (CARA) that was passed, but not fully funded, earlier this year. He seems to recognize the need for quality mental health care and addiction services to be offered to keep Americans healthy and to stem the tide of accidental opioid overdose deaths that have claimed tens of thousands of American lives.
The problem with CARA is that it is meant to be paired with insurance from private carriers or the ACA. There is a great deal of consensus on how to treat opioid addiction for long term recovery. Short term interventions like medication assisted treatment (MAT) can be highly effective, when used in conjunction with psychotherapy and other interventions. Without supportive care, the therapies in CARA might decrease overdose rates short term, but cannot be expected to make a real dent in the addiction problem.
At present, we can remain hopeful that key aspects of the ACA will be retained. If not, all of our healthcare institutions will need to move to figure out how we will continue to provide care to those who need it. As healthcare providers, our first course of action must be to treat the ill.