During this political season, and with the recent confirmation of Justice Amy Coney Barrett, a lot of attention has been focused on the Affordable Care Act (ACA), including what eliminating it might mean to those with pre-existing conditions, and the impact on those who currently get their health insurance through healthcare.gov or one of the state-based exchanges.

But while most of this talk has centered on the “physical” healthcare aspects of the ACA, one essential feature of the healthcare law and its concurrent expansion of Medicaid eligibility has gone largely unreported: namely how it impacts millions of Americans suffering from a substance use disorder who would suddenly be left to fend for themselves as their access to life-saving treatment and recovery services would be eliminated.

As it stands today, programs like Integrity House are able to help thousands of individuals who previously were not eligible for Medicaid. Moreover, prior to the ACA and Medicaid expansion in New Jersey, many people with substance use disorders needed to be involved in the criminal justice system to qualify for a bed at a program that relied on public funds. Today, access has been expanded for virtually all who need help – with an added benefit that an unnecessary, costly and ultimately damaging burden has been lifted from our police, courts and corrections system.

Killing or gutting the ACA with nothing to replace it would have far-reaching consequences for those in the process of addressing their substance use disorder issues. This, in turn, would bring on drastic and chaotic consequences across the overall health care spectrum. Because the ACA and the Medicaid expansion made health insurance and addiction treatment more accessible, millions of Americans with substance use disorders have been able to access necessary treatment services. Many have reclaimed their lives, rebuilt their familial relationships, and are making positive societal contributions as a result.

Among the over four million people on Medicaid who were treated for substance use disorder last year, fully 38 percent – more than 1.5 million of our fellow citizens – were eligible only as a result of the Medicaid expansion that was enacted as a part of the ACA. Losing this benefit as a result of a unilateral gutting or repeal of the Affordable Care Act would produce a myriad of dire and often unintended consequences across society. And, ultimately, rather than saving money, it will end up costing society far more down the road.

Adding to this potential societal calamity, the COVID-19 pandemic has exacerbated the addiction crisis, with widespread reports of depression and anxiety leading to increased drug and alcohol use, creating an even greater need for treatment and recovery services. The loss of the benefits afforded through the ACA in this time of global pandemic would be crushing.

Mental health advocates, addiction specialists and health policy researchers agree: the elimination of the Affordable Care Act would be dire not only for those who depend on it for their physical healthcare, but also for the approximately 20 million Americans with a substance use disorder. Suddenly killing the ACA and taking insurance and Medicaid coverage from a population that’s disproportionately impacted in terms of access to treatment will be disastrous on many levels, leading to a loss of lives, broken families, increases in violence and additional unnecessary burdens on society.

Robert Budsock President and CEO, Integrity House

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