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Health reform: Addiction no longer left on the outside

March 25, 2010
by Gary A. Enos, Editor
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The substance use treatment community’s interests are served in numerous places in the signed legislation

The days when the addiction treatment community would have to wait years for their stake in landmark national legislation (remember the “limited parity” law in the 1990s?) might seem centuries away to those who have examined the newly adopted health reform legislation. Numerous references to addiction services and professionals in the Patient Protection and Affordable Care Act indicate an inclusiveness that the substance use provider and patient communities had not come to expect less than a generation ago.

As State Associations of Addiction Services (SAAS) proclaimed in a news update on the day President Obama signed the bill into law, “When the law is fully implemented, 32 million Americans who are uninsured today will have access to health insurance coverage that includes mental health and substance use disorder treatment services at parity.” New Medicaid eligibles under the law will see addiction services as a mandated benefit in the minimum benefits package, while all health plans in the individual and small group markets will be required to offer addiction and mental health benefits under terms that reflect the comprehensive federal parity act.

Much of the change in the healthcare marketplace will not take shape for four years, and that might be the amount of time the field will need to understand all the implications of this sweeping new law, especially in less-publicized areas such as preventive services and healthcare workforce development. There also are ample opportunities for further refinements, to say nothing about how the public will react and how it will treat both supporters and opponents of the law in this fall’s elections.

Yet this week, addiction field leaders were proclaiming a full turning of the corner in terms of how policy leaders are viewing substance abuse services vis-à-vis the rest of healthcare.

“Today’s historic bill signing ceremony capped a 17-year effort to bring treatment of diseases of the brain in line with the treatment of diseases of the body and built on the foundation laid by the field’s historic parity victory,” SAAS stated in its alert.

An area that has received relatively little attention to date, but one that is bound to resonate with the leading professional groups in the addiction field, involves the new law’s multiple provisions on development of the behavioral health workforce. The law’s section on substance use and mental health workforce development includes:

• A loan repayment program that in part targets professionals choosing to practice in the underserved areas of child and adolescent behavioral services.
• Priority funding status for institutions that emphasize the needs of vulnerable populations and that embrace evidence-based approaches to treatment and prevention services.
• A $10 million authorization for developing the behavioral health workforce in child and adolescent services.