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Health Reform: What It Means for People With Substance Use and Mental Disorders

Richard Frank

07 Health Care Reform

Ask the Expert:  Richard G. Frank, Ph.D., is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School.

1) Question: I have been reading material on Behavioral Economics and feel it could help with a discussion of choice in the addiction field. Do you have any thoughts on this new area of research?

Answer: I think this is an enormously fruitful line of thinking and research and holds many applications to the mental and substance use disorder field. There are two important lines of research that you might start with. One looks at the circumstances and decision making distortions that result in substance use and addiction. The focus here tends to be on myopia or present bias. That is where people do not take adequate account of the long term consequences of their choices. The second line of research focuses on how people make choices about treatment when they face a complex and large array of options. A few things to read include the papers in Peter Diamonds edited volume Behavioral Economics and Its Applications Princeton University Press 2007; Paul Slovic and colleagues paper in Socio-economics 2002; Daniel Kahneman’s paper in the American Economic Review in 2003.

2) Question: Does the ACA mandate coverage for mental health and substance misuse disorders as a required benefit and specifically, is Medication Assisted Therapy - methadone and buprenorphine - to be covered by both ACA and the mental health/substance abuse Parity legislation?

Answer: The ACA requires that mental health and substance use disorder treatments be covered as part of the essential benefits package. The ACA also includes parity provisions. The essential benefits package is tied to “typical” private insurance coverage. Specific services are not articulated in the Act in the way your question suggests. However, parity requires that comparisons be made within classes of services including pharmaco-therapy. Thus answer to your question will be tied to whether typical private insurance that adheres to parity covers those services.

3) Question: Since we know that Medication Assisted Therapy can help people in recovery, help them work, etc. why can't we make it more affordable and accessible to those without insurance, i.e., the ability to pay for medication? Is coverage of Medication Assisted Therapy specified or is it "implied" with no specificity?

Answer: It is anticipated that expansion of coverage under the ACA will reduce the number of uninsured people and that they will be covered for substance abuse treatments because of parity and the terms of the essential health benefit. How treatment is delivered to uninsured people is largely a matter left to states, localities and provider organization. SAMHSA through a number of efforts is encouraging the use of evidence based treatments to all people in treatment for behavioral health problems. Clearly, advances in MAT are drawing much interest from the field.

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