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What will the fate of the Affordable Care Act mean for substance use treatment?

Medicaid is the largest source of funding for behavioral health treatment in the country, paying approximately $60 billion in 2014 for behavioral health services, including those related to substance use disorders.State Health Reform Assistance Network, Medicaid: States’ Most Powerful Tool to Combat the Opioid Crisis, 1, (New York: State Health Reform Assistance Network, 2016). Medicaid has also played an increasingly important role in the opioid crisis. 

With Medicaid expansion under the Affordable Care Act (ACA), an additional 1.2 million individuals with substance use disorders have gained access to health coverage and are guaranteed comprehensive behavioral health prevention and treatment services.State Health Reform Assistance Network, Medicaid: States’ Most Powerful Tool to Combat the Opioid Crisis, 1, (New York: State Health Reform Assistance Network, 2016).  A 2017 study examining data between 2001 and 2008 demonstrated that states with Medicaid expansion experienced meaningful reduction in the rates of robbery, aggravated assault, and larceny, likely explained by increasing the rate of treatment for substance use disorders.Hefei Wen, Jason M. Hockenberry, and Janet R. Cummings, “The Effect of Medicaid Expansion on Crime Reduction: Evidence from HIFA-waiver Expansions,” Journal of Public Economics 154, no. 1 (2017), 67-94.  Though some have claimed that Medicaid expansion has contributed to the worsening opioid epidemic, experts have concluded there is little evidence for this argument.Andrew Goodman-Bacon and Emma Sandoe, “Did Medicaid Expansion Cause The Opioid Epidemic? There’s Little Evidence That It Did.,” Health Affairs, August 23, 2017.