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And we wait for the Court some more

June 21, 2012
by Gary A. Enos, Editor
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Leaders look to what will come of Medicaid, insurance exchanges
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 As of sometime next week, will the Affordable Care Act (ACA) be upheld, overturned, or reopened to what would promise to be an incendiary debate on Capitol Hill? Where will this leave the addiction treatment community, as it monitors the components of health reform that at this point stand to bring in millions of newly insured individuals with substance use disorders by 2014?

We will know officially by sometime on the week of June 25 (perhaps as early as Monday, but not certain to be that day), the week when the U.S. Supreme Court issues its remaining opinions for the term. With a slight majority of analysts nationally predicting on the basis of the Court’s oral arguments on the ACA case that the healthcare law’s individual mandate for purchase of insurance will be overturned, addiction field leaders are wondering whether other aspects of the law, such as the planned expansion of Medicaid eligibility in 2014, could ultimately be left standing.

The timing of next week’s decision creates an intriguing scenario for directors of state substance abuse agencies, as the annual conference of the National Association of State Alcohol and Drug Abuse Directors (NASADAD) will be getting under way simultaneously in Savannah, Ga. And of course, the perspectives of state directors and their bosses in state government vary considerably, with some states having embarked on ambitious insurance expansions well before Obamacare became part of the nation’s vocabulary while others more recently joined the legal effort to overturn the ACA.

“Everyone is monitoring and everyone wants to know, ‘What will happen if there is only a partial upholding? What pieces will stand?’” says Michelle Dirst, NASADAD’s director of public policy.

News reports have indicated that if, as some expect, the Court overturns the individual mandate but lets part of the ACA stand, House Republicans will move immediately to have the entire act repealed. But given that relatively few legislative days in Congress remain before the 2012 election season kicks in, the chance that Congress could comprehensively tackle a reopened healthcare law in any fashion seems remote, says Rob Morrison, NASADAD’s executive director.

Unless the ACA in its entirety remains intact in the wake of the Supreme Court’s decision, the questions addiction field leaders immediately will ask are what will become of Medicaid expansion and of health insurance exchanges that under the law at present must offer substance use disorder services at parity with general health. These are the vehicles for the kind of access enhancements that many addiction professionals see as making a difference in closing the treatment gap that plagues many of those who need substance use services.

Visit this site over the course of next week for field comments and analysis on the Supreme Court’s much-anticipated decision.