If you’re familiar with the ACA (Affordable Care Act), also known as Obamacare, you also know that the passing of this legislation represented one of the biggest overhauls in American healthcare. According to the United States Department of Health and Human Services, the ACA provided health coverage to more than 16 million Americans who did not have it prior to the passing of the legislation. Amendments have been made to the ACA that are designed to benefit those struggling with addiction. 




While the passing of the ACA provided access to healthcare for many individuals, the amendments made have streamlined the process for receiving treatment. These changes have had an impact on not only the local health insurance market but also Medicaid. It is now easier for those who do not have insurance to get the treatment they need and return to a life of normalcy.


So what are the specific details of the ACA’s newly enacted amendments? Substance abuse has been officially adopted as an aspect of the Affordable Care Act, becoming part of the legislation’s 10 essential benefits of healthcare. In 2014, $50 million was earmarked to help fund treatment for those with substance abuse problems. The coverage offered is not the most comprehensive, but it is a step in the right direction.


As you can probably imagine, substance abuse treatment under traditional health insurance, Medicare, or Medicaid can be rife with complexities. For example, certain substance abuse treatments, while available, are not always guaranteed. Those who need these services will want to consult with their respective insurance provider to confirm what services are covered based on their policy.




As a means of establishing parity, the Affordable Care Act, under Medicare part A, requires co-payments for hospitals stays related to substance abuse to be commensurate with that of other medical procedures.


Under Medicare part B, 80 percent of recovery services will be covered as long as they recognized and approved under Medicare’s drug recovery program. To put this into context, this coverage is on par with what is offered to treat regular medical conditions. The remaining 20 percent, like with medical coverage,  will have to be absorbed by supplemental insurance or chalked up as an out-of-pocket expense.




Federal Legislation affecting substance abuse can be viewed as an extension of the Drug Addiction Treatment Act (DATA) of 2000. DATA it is a piece of legislation that allowed for the expansion of medication-assisted opioid dependency treatment. This law granted physicians the permission they needed to be able to prescribe medications like Suboxone and Subutex to patients trying to overcome opioid addiction. Beyond that, DATA also made it possible for physicians to treat patients in their office as opposed dedicated drug treatment facilities.




In understanding the full scope of the government’s role in healthcare access, it is important to acknowledge the three branches of government as they apply to healthcare. These branches include the legislative, executive, and judicial, and collectively, they have contributed to the expansion in all areas of health, including substance abuse treatment. This is significant since addiction is viewed as a disease, and under federal laws, patients cannot be denied coverage due to any preexisting conditions.




There has been a significant shift in making substance abuse treatment more accessible. There is so much more that needs to be done, but as a country, we are making significant headway.

If you are struggling with addiction, regardless of your financial situation, please contact us!