A Response to President Obama’s Health Care Reform Article

President Obama recently published an article discussing the Affordable Care Act (2010) in the Journal of the American Medical Association (JAMA).

This publication is monumental for being the first medical article ever to be published in a journal by a president. It is a useful resource for members of the public, especially researchers, who want to gain a better understanding of the president’s perspectives and the progress made with health care reform.


Accomplishments of the Affordable Care Act

In this article, President Obama stated that health care reform is necessary because, at the rate health care costs are increasing, medical services will soon be inaccessible to practically everyone. One of the most significant accomplishments of health care reform has been the decrease in the number of people who are uninsured; 49 million individuals were uninsured in 2010 and that number dropped to 29 million in 2015. Additionally, there has been a decline in Medicare expenditures per enrollee and hospital readmission rates. Obama comments that continuing Medicaid expansion and increasing transparency are needed to move forward and affect positive change.


Health Care Reform Related to Substance Use

Obama’s publication did not go into detail about the state of health care reform in regards to substance use disorders. He briefly mentioned the Tobacco Control Act (2009) and reduced smoking rates in teens but otherwise wasn’t focused on the topic. However, the Affordable Care Act (ACA) has mandated a number of changes in the health care field that will change the face of substance use treatment for the better.


Insurance Companies Are Required To Cover Addiction Services

In the past, health care insurance rarely covered addiction treatment, making it an expensive disease to treat. Medicaid funded addiction services for persons with disabilities, but because this was controversial it became illegal with the Contract with America Advancement Act of 1996.

A minor revolution occurred with the Mental Health Parity and Addiction Equity Act of 2008, which required existing health care coverage packages for addiction treatments to have the same deductibles, copays, treatment limitations, and out-of-network coverage as medical/surgical care coverage. However, it was not until the ACA passed that coverage for addiction treatment was required in a standard health care plan. This Act extended coverage to everyone on Medicaid/Medicare, large and small employer plans, and individual plans. It also expanded eligibility for Medicaid.

The small company-sponsored health care plans and extension of Medicaid in some states has been quite controversial and has led to a number of persons not acquiring health care insurance at all. Despite this setback, millions have gained better access to addiction treatment care. It is anticipated that this number will further improve because the remaining states that have not expanded Medicaid are predicted to do so once they realize the fiscal benefits.


Addiction Services Will Be Integrated into Health Care Homes

Addiction care services have historically operated separately from the regular health care system. This separation has been a detriment to the healthcare field; the effects of addiction on the body are significant, and dissociating medical and addiction care has complicated treatment unnecessarily for patients while making addiction treatment failures more common. The ACA attempts to remedy this issue by requiring the integration and collaboration of addiction treatments centers with primary care facilities.

Collaborations with primary health care providers and integration into patient-centered health care homes (such as Federally Qualified Health Centers) will allow for the eventual coordination of medical care with substance use disorder treatments. There is also some speculation that this change may lead to the development of a system that prevents drug addiction from occurring in the first place. However, these developments may take decades to realize.


Increased Training for Substance Use Counselors

With a lack of influence from health insurance companies and dissociation from other medical practices, there has been little incentive for addiction treatment centers to provide highly trained staff. Most states have low (or no) standards for facilities that wish to obtain licenses for addiction treatment services. Reflective of these low standards, fewer than half of addiction treatment providers in the United States have degrees or formal addiction treatment certifications. (See about us for our credentials.)

With the requirement of health insurance companies to pay for addiction treatment has come an increase in facilities obtaining trained staff to meet the insuring companies’ credentialing requirements. In years to come, addiction treatment programs will have a higher percentage of highly trained staff knowledgable of the practices that work best to resolve problems with drug addiction. This should result in better treatment and improved care for patients across the United States. There may even be a burst in research and publications leading to better addiction treatment strategies.


The Current Status of Addiction Treatment

Addiction treatment facilities have a long way to go. Establishing collaborations with primary health care facilities, installing electronic medical record systems, training staff, acquiring Medicaid certification, and acquiring credentials to become an in-network addiction provider are all major advancements, and the access to the funding needed to enact all of these changes has not increased by much. It will be years before addiction treatment centers can succeed in all these endeavors without states supplementing the federally funded efforts. Despite the current financial problems, which are holding up access to treatment, the future for addiction treatment looks brighter than it did pre-ACA.


http://onlinelibrary.wiley.com/doi/10.1111/add.12606/epdf editorial on ACA




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