Affordable Care Act

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. This puts in place comprehensive health insurance reforms that will roll out over four years and beyond.

Health reform includes several key steps in the next 4 years. Medicaid will be expanded to allow more people at the lowest income levels to qualify for coverage. Employers will be encouraged to offer health insurance. Moderate income Americans who do not qualify for Medicaid will be given credits to purchase private health insurance coverage. The purchase of health insurance will be streamlined through the establishment of the Health Insurance Exchange. The ACA will strengthen consumer protections, impose protections to guard against unreasonable rate increases and require transparency from health insurance companies. The focus of the ACA will be on primary and preventive care. All Americans must purchase health insurance so that everyone pays for the cost of health care.

Substance Abuse and the Affordable Care Act

The Affordable Care Act (ACA) put in place comprehensive health insurance reforms that will make health insurance available to many more people, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

The ACA includes substance use disorders as one of the 10 essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2014 must include services for substance use disorders.

By including these benefits in health insurance packages, more health care providers can offer and be reimbursed for these services, resulting in more individuals having access to treatment. The specific substance abuse services that will be covered are currently being determined by the Department of Health and Human Services, and will take into account evidence on what services allow individuals to get the treatment they need and help them with recovery.

New York

Federal health reform establishes significant nationwide consumer protections in commercial health insurance markets. A number of key consumer health insurance protections already in place in New York have been adopted as a part of federal reform. As a result, New York will go through less transition than many states with respect to these reforms.

What are Health Exchanges?

Under the federal Affordable Care Act, an Exchange will be operating in every state starting in 2014. States have the option to either set up an Exchange themselves or to allow the federal government to set up an Exchange in their state. New York has chosen to set up its own Exchange, called the New York Health Benefit Exchange. On April 12, 2012, Governor Cuomo issued Executive Order #42 to establish it within the NYS Department of Health where most New Yorkers will purchase their health care.

The Basics – What Has Changed

Coverage

  1. Ends Pre-Existing Condition Exclusions for Children.
  2. Keeps Young Adults Covered (under parent’s plan to age 26).
  3. Ends Arbitrary Withdrawals of Insurance Coverage.
  4. Guarantees Your Right to Appeal.

Costs

  1. Ends Lifetime Limits on Coverage.
  2. Reviews Premium Increases.
  3. Helps You Get the Most from Your Premium Dollars.

Care

  1. Covers Preventive Care at No Cost to You (No copayment).
  2. Includes Drug Disorder Treatment as an Essential Benefit.
  3. Protects Your Choice of Doctors.
  4. Removes Insurance Company Barriers to Emergency Services.

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Resources

Substance Abuse and Mental Health Services Administration SAMHSA (pronounced Sam-Sa)

http://www.samhsa.gov/

The lead federal agency for substance use and mental health and an agency of Health and Human Services (HHS). Do a search at SAMHSA there are many articles and publications you can order for free from their bookstore the National Clearinghouse for Drug and Alcohol Information (NCADI, pronounced N-Cadi). While there you can order TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs – this is The Best Practice Book for methadone and buprenorphine and how programs should operate.

New SAMHSA Health Reform Section

http://beta.samhsa.gov/health-reform

By 2014 this link will be changed (probably www.samhsa.gov/health-reform).

The White House – Health Reform in Action

http://www.whitehouse.gov/healthreform

Get information about all that is happening as health reform is implemented. Get tweets from @HealthCareGov.

The White House – FaceBook Page

https://www.facebook.com/Healthcare.gov

https://www.healthcare.gov/

Healthcare.gov The federal website for information and where after October 1st you can enroll in healthcare. Subscribe to the list for email updates at Healthcare.gov/subscribe.

Centers for Medicare and Medicaid Services (CMS)

http://www.cms.gov/

The federal agency for Medicare and Medicaid that is going through an expansion of those services.

NYS Office of Alcoholism and Substance Abuse Services (OASAS)

http://www.oasas.ny.gov/

The New York state agency for substance use services. Go to the website and do a search on health reform for updates about what is happening.

New York Health Benefit Exchange

http://healthbenefitexchange.ny.gov/

Through the Exchange, New Yorkers will be able to easily compare health insurance options and enroll in health insurance coverage through a website, over the phone, in-person or by mail.

Information is being added to this section on the Affordable Care Act come back often. By 2014 it will include nationwide information.

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