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Addiction leaders express relief that ACA survives

June 28, 2012
by Gary A. Enos, Editor
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Attention will turn to individual states' responses
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 Moments after the nation’s highest court upheld the individual mandate that is the cornerstone of the Obama administration’s health reform law, the first audible reaction from the addiction treatment world came in the form of a rousing “woohoo!” from the overseer of clinical services at nationally prominent Phoenix House.

“Good sign that expansion of addiction coverage will remain intact,” Deni Carise, Ph.D., wrote in her Twitter post this morning, as the key points of the U.S. Supreme Court’s decision on the Affordable Care Act (ACA) were still being extracted.

(Carise’s efforts to reshape clinical care at one of the nation’s largest nonprofit addiction treatment organizations were featured in Addiction Professional’s March/April 2012 cover story, and she will be a keynote presenter this September at the National Conference on Addiction Disorders.)

The Court’s much-anticipated decision was garnering immediate reactions among leaders of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), who were gathered in Savannah, Ga., for their annual meeting. “We are pleased that there will be clarity on the constitutionality of the ACA and that state substance abuse agencies can better plan how to address the needs of individuals with substance use disorders,” said Michelle Dirst, NASADAD’s director of public policy.

Yet the extent to which that planning can take place, especially in states where political leaders have opposed the ACA to this point, will depend largely on how the governors and legislators in those states decide to proceed. News reports have suggested that in states such as Florida, South Carolina and Wisconsin, Republican governors who do not share the Obama administration’s perspective on health reform would prefer to wait until after the November elections to see if the landscape at that point would favor repeal of the ACA on Capitol Hill.

There also have been indications that the U.S. House of Representatives will move to schedule hearings soon on repealing the ACA, but with no similar inclination in the Senate and the fall campaign season looming, few were expecting any immediate traction on congressional action regardless of what the Court was to announce today.

“Given the politics of this Congress, it would be difficult to get something presented in a nice bow,” NASADAD executive director Rob Morrison said last week, as the field awaited the Court’s decision.

While the intricacies of the law’s individual mandate being upheld under taxing authority will likely capture many of the early headlines, the addiction treatment community is apt to pay close attention as well to the Court’s ruling this morning on the ACA’s Medicaid expansion provision.

While the Court stated this morning that the federal government can withhold expansion funding from states that do not comply with the ACA’s Medicaid expansion provisions, it cannot withhold existing Medicaid funding (states’ base funding) for a lack of compliance with these provisions. That could call into some question the issue of whether some states will see the jump in Medicaid enrollment that many addiction treatment advocates believe is critical to closing the treatment gap that leaves many people with substance use disorders without access to care.

Some of the nation’s most prominent addiction treatment leaders began to weigh in on the ruling with statements of relief. Hazelden president and CEO Mark Mishek emphasized the importance of the ACA’s health insurance exchanges and their products’ inclusion of addiction treatment services as an essential benefit.

“This historic, life-saving ruling lifts the burdens and obstacles that had been set before those who wished to find freedom from the disease of addiction,” Mishek said in a news release.