After a federal judge ruled Friday that the Affordable Care Act is unconstitutional, President Donald Trump enthusiastically praised the decision as “Great news for America!”
The ruling will inevitably be appealed and most likely overturned. Should it stand, however, that “great news” would translate to more than 17 million Americans losing health care coverage and the uninsured rate rising by 50 percent, according to an Urban Institute analysis.
With the health care law temporarily in flux, it’s worth revisiting an often-unacknowledged aspect of how the ACA helps underserved Americans: It’s a key tool in addressing our nation’s opioid epidemic.
“If we are serious about treating addiction as a public health issue, and bending the curve of the opioid epidemic, we must maintain the Affordable Care Act and Medicaid expansion,” said Regina LaBelle, the former chief of staff at the White House Office of National Drug Control Policy during the Obama administration.
“If we are serious about treating addiction as a public health issue, and bending the curve of the opioid epidemic, we must maintain the Affordable Care Act and Medicaid expansion.”
- Regina LaBelle, former chief of staff, White House Office of National Drug Control Policy
In addition to requiring that addiction treatment be on par with physical health insurance coverage, two specific parts of the ACA have made addiction treatments, such as medication-assisted treatment and inpatient and outpatient therapies, more accessible.
First, the ACA guarantees health insurance coverage, regardless of pre-existing conditions.
“A person with a history of substance use cannot be denied health coverage,” explained Leighton Ku, a professor at George Washington University’s Milken Institute School of Public Health.
Secondly, the law allows young adults to stay on their parents’ insurance until age 26.
“As we know, addiction is a disease of early onset, and the earlier we can intervene, the better,” LaBelle said. “That’s why allowing young people to stay on their parent’s insurance is important.”
Another critical tool, according to experts, is expanding Medicaid to all low-income adults under the ACA.
And while conservatives have argued that expanding Medicaid made the opioid crisis worse, research published earlier this year comparing expansion states to non-expansion states debunked that claim.
Instead, prescription fills for addiction medicine, combined with the opioid reversal antidote naloxone, significantly increased in expansion counties, indicating that more people were receiving treatment.
“This supports the idea that Medicaid expansion has been beneficial in increasing the number of people receiving an important addiction treatment,” Brendan Saloner, lead author of the study and assistant professor at the Johns Hopkins Bloomberg School of Public Health, previously told HuffPost.
Thirty-six states, plus Washington D.C., had enacted the policy or were planning to do so as of December.
In addition to expanding addiction treatment, Saloner noted that expanding Medicaid shifted the burden of funding addiction treatment off of state and local budgets and onto the federal government, potentially freeing up funds in those states to improve the patchwork of treatment services they offer.
The expansion was also associated with a decrease in crime, he said, noting that in addition to health implications, addiction touches on areas such as public safety, child welfare and employment.
Most of all, Saloner stressed that the opioid epidemic, which killed nearly 50,000 Americans in 2017, could have potentially been even worse.
“Without Medicaid expansion, I believe that the already devastating opioid crisis would be both more severe and more expensive for state governments,” he said.