DISCLAIMER: This post is not political in nature, but simply a discussion of how changes mandated by the ACA affect access to substance abuse treatment.
There are many employers who, out of compassion, allow substance abusers to continue to work without intervention. They want to do what’s best for the employee, but can’t afford to pay for their treatment. As a result, the problem remains unaddressed which is unfortunate for both the employee and the business. The employee’s addiction progresses and the quality of their work and their quality of life deteriorate.
The Affordable Care Act has mandated changes to health insurance that will provide employers with more options for addressing substance abuse. Access to substance abuse treatment will increase on three levels:
- Increased Health Insurance Coverage: More employees will have access to health insurance either through the individual market or through small group coverage. According to HHS.gov, approximately 48,000 individuals have enrolled in health insurance coverage through the individual marketplace or the expanded Medicaid system. In addition, businesses with fewer than 25 employees qualify for a 50% tax credit for providing health insurance coverage to their employees. Once an individual is covered by a health insurance plan, an employer is able to intervene and refer them for treatment.
- Substance Abuse Treatment Covered at Parity: The ACA expands the Mental Health Parity and Addiction Equity Act of 2008 which requires mental health and substance abuse disorder coverage to be comparable to coverage provided for other medical issues. Not only does this parity increase coverage for substance abuse disorders, but it recognizes addiction as a disease (as opposed to a lack of will power or moral transgression). The expansion requires all individual and small group insurance policies to include mental health and substance abuse disorder coverage as an Essential Health Benefit. This expansion has brought mental health and substance abuse disorder parity coverage to an additional 253,680 NH residents.
- Free Preventive Medicine: Many health insurance policies will provide preventive services with no co-pay or deductible. Annual preventive visits will increase treatment for substance abuse. Frequently, physicians will do a brief substance abuse screening at a check-up, allowing them to identify and address substance abuse disorders. Additionally, individuals who have an ongoing relationship with a physician will feel more comfortable asking for a referral for substance abuse services. They will already have an access point into the health care system.
Review Your Coverage! This is a great time for employers to review their health insurance coverage. Does the plan you offer your employees cover substance abuse disorders at parity with other medical coverage? If you were previously unable to offer health insurance coverage, you may be able to now. Determine if your business qualifies for any tax credits. This is also a great time to offer a lunch-and-learn for your employees: either educate them about what is covered under their health insurance plan or educate them about what is available to them on the individual market. You should be able to find an insurance representative or insurance agent who is willing to provide this education free of charge.
If you want to refer an employee for treatment, but need help appropriately addressing the issue, we’re here to help. Contact us at www.substancefreeworkplace.com.