It was hoped, and intended, that the Affordable Care Act (popularly called Obamacare) would make substance abuse treatment available to people with pre-existing conditions. The insurance industry has responded by making it extremely difficult to get treatment without paying in full—out of pocket—or paying extremely high deductibles.
If an insurance company has been successful in delisting treatment as a covered benefit, then those seeking recovery face the full cost of a program. With deductibles reaching as high as $25,000, people seeking treatment are going to find it prohibitively expensive, even if they can afford it. The high price tag can act as an additional disincentive to make a commitment to recovery.
Furthermore, insurance companies now deem outpatient addiction services more effective, leading to a proliferation of providers, at the expense of coverage for detox. When detox is covered, it can be selective, with crystal meth and cocaine exempted.
Insurance companies are, of course, in the business of assessing risk and determining the cost of sharing that risk with consumers. Interestingly, some insurance companies, like Aetna and Cigna, provide reasonable coverage for substance abuse treatment. This makes it reasonable to question other insurers’ protests regarding protecting their bottom lines. As a national policy issue, however, the cost of addiction to society—in terms of lost productivity, medical emergency expense, criminal justice costs, and personal misery—is so enormous (estimated at $260 billion in 2003, according to the Surgeon General)—that making effective treatment available should be a goal for any administration, regardless of its philosophy regarding social programs.
Following the law of unintended consequences, unfortunately Obamacare has made it more difficult to access substance abuse treatment as insurers have moved to consolidate their bottom lines. So far, only individual policies have been affected, but group policies could be next.