The House Republican bill to replace the Affordable Care Act: What treatment centers need to know

On March 6, 2017, the American Health Care Act (AHCA) was introduced in the United States House of Representatives as the fulfillment of the Republicans’ promise to repeal and replace the Affordable Care Act (ACA). The AHCA according to House Speaker Paul Ryan, “means lower costs, more choices, and greater control over your healthcare.”

For alcohol and drug treatment centers, the Affordable Care Act codified gains made in mental health parity, and required that health insurance policies offered in the marketplace cover, among other things, mental health and substance abuse disorder services. Moreover, the ACA, through expanded Medicaid coverage in some states and the purchase of policies on the marketplace exchanges, has increased the number of people with coverage by at least 10 million people. Of course, alcohol and drug treatment centers benefit from the ACA’s protection of mental health parity and also from the increased number of patients with insurance covering substance use disorders. For addiction treatment centers, several questions arise regarding the American Health Care Act:

Does the American Health Care Act impact mental health parity and coverage for substance use disorders?

No. According to the analysis of the proposed legislation undertaken by the Henry J. Kaiser Family Foundation,[1] the ACA’s requirements that health insurance cover the 10 essential health benefit categories is not changed by the American Health Care Act as proposed. Thus, the ACA’s requirement that health insurance policies cover substance abuse disorders, for the time being, is not impacted by this new proposed legislation.

If enacted, would the American Health Care Act reduce the number of people with insurance coverage?

Unknown. In the days since introduction of this proposed legislation, there has been great debate about this question, but no definitive answer has emerged. If this legislation survives, we suspect the Congressional Budget Office will be asked to study this question. Although proponents of the Act laud its other benefits, the impact on the number of people with coverage has not been discussed as a goal (or even a consequence) of the Act in the introduction of the legislation. In fact, in the opening press conference, Health and Human Services Secretary Tom Price was asked whether he could guarantee that this bill would not result in millions of Americans losing health insurance, but Price did not answer the question.

What is the likelihood that the American Health Care Act as proposed will become law? Low. The proposed legislation was introduced by the Republicans in the House of Representatives, where the Republicans enjoy a substantial majority. Already, however, members of the House Freedom Caucus, a group of conservative House Republicans numbering about three dozen, have denounced the new legislation. Other conservative organizations have pronounced the new effort dead. If the Freedom Caucus voted as a bloc, they could derail this new legislation on their own. Moreover, the Republican margin in the Senate is even smaller, and defection of two or more Republicans could threaten passage in that chamber. Thus, at the present juncture, passage of this Act in this form is unlikely.

Walter H. Boone is a partner with Balch & Bingham, LLP, a corporate law firm with offices across the Southeastern United States. Balch & Bingham, LLP is an Advisor to the American Addiction Treatment Association (AATA), a national trade association that provides online resources and training events, for licensing and certification, operations, reimbursement, clinical standards, patient privacy, quality assurance, and risk management.