On May 3, 2017, NAADAC, the Association for Addiction Professionals, along with 434 other organizations representing consumers, families, providers, health care and social service professionals, advocates, and allies, sent the following letter to Speaker Paul Ryan and Leader Nancy Pelosi to express its opposition to the most recent version of the American Health Care Act (AHCA):
Dear Speaker Ryan and Leader Pelosi,
The undersigned organizations are writing to share our views on the most recent version of the American Health Care Act (AHCA). We are very concerned that the AHCA’s proposed changes to our health care system will result in reductions in health care coverage, particularly for vulnerable populations including those suffering from substance use disorders and mental illness, and we continue to be unable to support the bill in its current form.
We collectively represent consumers, families, providers, health care and social service professionals, advocates and allied organizations who are committed to meaningful and comprehensive policies to reduce the toll of substance use disorders and mental illness through prevention, treatment and recovery support services.
More than 20 million Americans currently have health care coverage due to the Affordable Care Act (ACA), including millions of Americans with substance use disorders and mental illness. This coverage is a critical lifeline for these individuals, many of whom were unable to access effective treatment before the ACA’s expansion of Medicaid eligibility to low-income adults, and its requirement that Medicaid expansion plans and plans sold in the individual and small group markets provide essential health benefits (EHB) including substance use disorder and mental health treatment services at parity with medical and surgical services.
In the face of the opioid overdose and suicide epidemics, equitable access to a full continuum of mental health and substance use disorder treatment services, including medications to treat substance use disorders and mental illness, must be an essential component of health care coverage. It is also critical that substance use disorders and mental illness be covered on par with other medical conditions consistent with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The Affordable Care Act (ACA) extended the applicability of MHPAEA to the small and individual group market as well as Medicaid expansion plans, which are currently required to offer substance use disorder and mental health services at parity with medical and surgical services. As authors writing in the New England Journal of Medicine recently noted, “Repeal of the ACA would dismantle these protections and turn the clock back to a time when most Americans were subject to restrictive and inequitable limits on coverage for medication treatment and other supplementary treatments for opioid use disorder.”
We remain concerned that provisions in the bill to roll back the Medicaid expansion, allow states to receive waivers from EHB requirements for private plans, sunset the EHB requirements for Medicaid expansion plans, and cap federal support for Medicaid beneficiaries will reduce coverage for and access to substance use disorder and mental health treatment services. The amendment being proposed by Representatives Upton and Long to provide funds to offset the costs of individuals with pre-existing conditions who cannot afford health insurance coverage does not address our serious concerns about these provisions in the AHCA that would reduce access to life saving substance use disorder and mental health treatment.
The Medicaid expansion in particular has led to significant increases in coverage and treatment access for persons with addiction and mental illness. In states that expanded Medicaid, the share of people with substance use disorders or mental illness who were hospitalized but uninsured fell from about 20 percent in 2013 to 5 percent by mid-2015, and Medicaid expansion has been associated with an 18.3 percent reduction in unmet need for addiction treatment services among low-income adults. Rolling back the Medicaid expansion and fundamentally changing Medicaid’s financing structure to cap spending on health care services will certainly reduce access to evidence-based treatments and reverse much or all progress made on the opioid crisis last year. Moreover, the loss of Medicaid-covered mental health and substance use disorder services for adults would result in more family disruption and out-of-home placements for children, significant trauma which has its own long-term health effects and a further burden on a child welfare system that is struggling to meet the current demand for foster home capacity.
Medicaid funding for mental health and substance use disorder treatment services for low-income populations must be predictable, sustainable, and integrated with financing mechanisms for general medical care to ensure consistent access to treatment and support the long-term development and retention of an addiction and mental health clinician workforce.
The ACA’s Medicaid expansion, EHB requirements for mental health and substance use disorder treatment coverage, and extension of parity protections to the individual and small group market have surely reduced the burden of the opioid misuse and overdose and suicide epidemics and saved lives. As you consider this legislation, we ask that you ensure substance use disorder and mental health treatment benefits continue to be available to Americans enrolled in the individual, small and large group markets as well as Medicaid plans and that these benefits are compliant with the Mental Health Parity and Addiction Equity Act.
Finally, throughout this process, we implore you to keep in mind how your decisions will affect the millions of Americans suffering from substance use disorders and mental illness who may lose their health care coverage entirely or see reductions in benefits that impede access to needed treatment.
1. Acadia Healthcare
2. Adcare Educational Institute
3. Addiction Education Society
4. Addiction Haven
5. Addiction Resource Council
6. Addiction Services Council
7. Addiction Policy Forum
8. Addiction Treatment Center of New England
9. Addictions Connections Resource
10. Advocates for Recovery Colorado
11. Advocates, Inc.
12. Alabama Society of Addiction Medicine
13. Alano Club of Portland
14. Alcohol & Addictions Resource Center
15. Alcohol/Drug Council of North Carolina
16. Alternatives Unlimited, Inc.
17. Amesbury Psychological Center, Inc.
18. American Correctional Association
19. American Federation of State, County and Municipal, Employees (AFSCME)
20. American Academy of Addiction Psychiatry
21. American Academy of Pediatrics
22. American Association for Marriage and Family Therapy
23. American Association for the Treatment of Opioid Dependence (AATOD)
24. American Association of Child & Adolescent Psychiatry
25. American Association on Health and Disability
26. American Congress of Obstetricians and Gynecologists
27. American Dance Therapy Association
28. American Foundation for Suicide Prevention
29. American Group Psychotherapy Association
30. American Medical Student Association
31. American Mental Health Counselors Association
32. American Nurses Association
33. American Public Health Association
34. American Psychiatric Association
35. American Psychological Association
36. American Society of Addiction Medicine
37. A New PATH
38. Anxiety and Depression Association of America
39. Arc of South Norfolk, The
40. Arise & Flourish
41. Arizona’s Children Association
42. Arizona Council of Human Service Providers
43. Arizona Society of Addiction Medicine
44. Arkansas Society of Addiction Medicine
45. Association for Ambulatory Behavioral Healthcare
46. Association for Behavioral Healthcare of Massachusetts
47. Association for Community Affiliated Plans
48. Association for Community Human Service Agencies
49. Association of Asian Pacific Community Health Organizations (AAPCHO)
50. Association of Flight Attendants – CWA, AFL-CIO
51. Association of Persons Affected by Addiction (APAA)
52. Association of Recovery Schools
53. Association of Recovery Community Organizations
54. Association of Women’s Health, Obstetric and Neonatal Nurses
55. A Stepping Stone to Success
56. Atlantic Prevention Resources, Inc.
57. Avanti Wellness
59. Bangor Area Recovery Network, Inc.
60. Bay Cove Human Services
61. Bay State Community Services, Inc.
62. Bazelon Center for Mental Health Law
63. Behavioral Health Network, Inc.
64. Better Life in Recovery
65. Bill Wilson Center
66. Boston Alcohol and Substance Abuse Programs, Inc.
67. Boston Healthcare for the Homeless
68. Boston Public Health Commission
70. Bridge of Central Massachusetts, Inc., The
72. Brien Center for Mental Health and Substance Abuse Services, The
73. Brookline Community Mental Health Center
74. Bullhook Community Health Center, Inc.
75. Burke Recovery
76. California Consortium of Addiction Programs & Professionals
77. California Council of Community Behavioral Health Agencies
78. California Society of Addiction Medicine
79. Cambridge Health Alliance
80. Camelot Care Centers, Inc.
81. Cape Cod Healthcare Centers for Behavioral Health
82. Capital Area Project Vox
83. Casa Esperanza
84. Casa Pacifica Centers for Children and Families
85. Catholic Charities Family Counseling and Guidance Center
86. Catholic Family Center
87. Center for Human Development
88. Center for Open Recovery
89. Center for Recovery and Wellness Resources
90. Central City Concern
91. Chautauqua Alcoholism and Substance Abuse Council
92. Chicago Recovering Communities Coalition (CRCC)
93. Child & Family Services, Inc.
94. Child and Family Services of New Hampshire
95. Children’s Friend, Inc.
96. Children’s Home Society of Washington
97. Children’s Law Center
98. Children’s Services of Roxbury
100. Clergy for a New Drug Policy
101. Clinical and Support Options, Inc.
102. Clinical Social Work Association
103. Coalition of Addiction Students and Professionals Pursuing Advocacy (CASPPA)
104. Colorado Society of Addiction Medicine
105. Community Catalyst
106. Communities for Recovery
107. Community Anti-Drug Coalitions of America (CADCA)
108. Community Counseling of Bristol County, Inc.
109. Community-Minded Enterprises
110. Community Oriented Correctional Health Services (COCHS)
111. Community Services Institute
112. Community Solutions
113. Community Substance Abuse Centers
114. Connecticut Community for Addiction Recovery (CCAR)
115. Connecticut Society of Addiction Medicine
116. Counselors Obediently Preventing Substance Abuse (COPS)
117. Cutchins Programs for Children and Families
118. DarJune Recovery Support Services & Café
119. Dash for Recovery
120. Davis Direction Foundation - The Zone
121. DC Fights Back
122. DC Recovery Community Alliance
123. Delphi Behavioral Health Group/MHD
124. Desert Eagle Addiction Recovery
125. Detroit Recovery Project, Inc.
126. Dimock Community Health Center
127. Disability Rights Pennsylvania
128. Doctors for Recovery
129. Dorchester Recovery Initiative
130. Drug and Alcohol Service Providers Organization of Pennsylvania (DASPOP)
131. Drug Policy Alliance
132. Drug Prevention Resources
133. East Bay Agency for Children
134. Easy Does It, Inc.
135. Eating Disorders Coalition
136. Edinburg Center, The
137. Eliot Community Human Services
138. El Paso Alliance
139. Engaged Recovery Community Services
140. Faces and Voices of Recovery
141. Facing Addiction
142. Family Focused Treatment Association
143. Family Service Association
144. Family Service of Greater Boston
145. FAVOR Greenville
146. FAVOR Low Country
147. FAVOR Mississippi Recovery Advocacy Project
148. FAVOR Pee Dee
149. FAVOR Tri-County
150. FED UP! Coalition
151. Fellowship Foundation Recovery Community Organization
152. Fenway Health
154. Florida Society of Addiction Medicine
155. Floridians for Recovery
156. Foundation for Recovery
157. Friends of Recovery - New York
158. FSA – Family Service Agency
159. Futures of Palm Beach
160. G III Associates
162. Gandara Center
163. Georgia Council on Substance Abuse
164. Georgia Society of Addiction Medicine
165. Global Alliance for Behavioral Health and Social Justice
166. Gosnold on Cape Cod
167. Granite Pathways
168. Greater Macomb Project Vox
169. Greater Philadelphia Association for Recovery Education
170. Great South Bay Coalition
171. Greater Cincinnati Recovery Resource Collaborative (GCRRC)
172. Griffin Recovery Enterprises
173. Harm Reduction Coalition
174. High Point Treatment Center
175. Hillview Mental Health Center, Inc.
176. HIV Medicine Association
177. Home for Little Wanderers, The
178. HOPE for New Hampshire Recovery
179. Hope House Addiction Services
180. Horizon Health Services
182. Illinois Association for Behavioral Health
183. Illinois Association of Rehabilitation Facilities (IARF)
184. Indiana Society of Addiction Medicine
185. International Nurses Society on Addictions
186. Institute for Health and Recovery
187. Iowa Association of Community Providers
188. Iowa Behavioral Health Association
189. Italian Home for Children, Inc.
190. Jackson Area Recovery Community
191. Jewish Family and Children’s Services (JF&CS)
192. Joint Coalition on Health
193. Jordan's Hope for Recovery
194. Judge Baker Children’s Center
195. Juneau Recovery Community
196. Justice Resource Institute (JRI)
197. Kentucky Society of Addiction Medicine
198. KEY Program, Inc., The
199. Kyes 2 a 2nd Chance
200. Lahey Health Behavioral Services
201. Lakeshore Foundation
202. Latah Recovery Center
203. Legal Action Center
204. Lifehouse Recovery Connection
205. Lifeline Connections
206. Long Island Council on Alcoholism and Drug Dependence, Inc.
207. Long Island Recovery Association (LIRA)
208. Lost Dreams Awaken Center, Inc.
209. Lotus Peer Recovery/SoberKerrville
210. Lowell Community Health Center, Inc.
211. Lowell House, Inc.
212. LUK, Inc.
213. Madison County Council on Alcoholism & Substance Abuse
214. Magnolia Addiction Support
215. Maine Alliance for Addiction Recovery
216. Mariah’s Mission Fund of the Mid-Shor Community Foundation
217. Mark Garwood SHARE Foundation
218. Martha’s Vineyard Community Services
219. Maryland-DC Society of Addiction Medicine
220. Maryland House Detox
221. Maryland Recovery Organization Connecting Communities (M-ROCC)
222. Massachusetts Organization for Addiction Recovery (MOAR)
223. Massachusetts Society of Addiction Medicine
224. McShin Foundation
225. Mental Health Association
226. Message Carriers of Pennsylvania, Inc.
227. Messengers of Recovery Awareness
228. MHA of Greater Lowell
229. Michigan's Children
230. Michigan Recovery Voices
231. Michigan Society of Addiction Medicine
232. Middlesex Human Service Agency, Inc
233. Mid-Michigan Recovery Services, Inc.
234. Midwest Society of Addiction Medicine
235. Mi-HOPE - Michigan Heroin & Opiate Prevention and Education
236. Minnesota Association of Community Mental Health Programs (MACMHP)
237. Minnesota Recovery Connection
238. Minnesota Society of Addiction Medicine
239. Missouri Recovery Network
241. Mountain View Prevention Services, Inc.
242. NAADAC – the Association for Addiction Professionals
243. National Alliance for Medication-Assisted Recovery (NAMA)
244. National Alliance on Mental Illness
245. National Alliance on Mental Illness – San Mateo County
246. National Alliance to Advance Adolescent Health
247. National Alliance to End Homelessness
248. National Association for Rural Mental Health
249. National Association of Addiction Treatment Providers
250. National Association of Clinical Nurse Specialists
251. National Association of Pediatric Nurse Practitioners
252. National Association of State Mental Health Program Directors (NASMHPD)
253. National Association for Children’s Behavioral Health
254. National Association for Rural Mental Health
255. National Association of Drug Court Professionals
256. National Association of Social Workers (NASW)
257. National Association of County Behavioral Health and Developmental Disability Directors
258. National Council for Behavioral Health
259. National Center on Addiction and Substance Abuse
260. National Council on Alcoholism and Drug Dependence
261. National Council on Alcoholism and Drug Dependence of E. San Gabriel & Pomona Valleys
262. National Council on Alcoholism and Drug Dependence--Greater Phoenix
263. National Council on Alcoholism and Drug Dependence – Maryland
264. National Council on Alcoholism and Drug Dependence – San Diego
265. National Council on Alcoholism and Drug Dependence of the San Fernando Valley
266. National Council on Alcoholism and Drug Abuse-St. Louis Area
267. National Disability Rights Network
268. National Federation of Families for Children’s Mental Health
269. National Health Care for the Homeless Council
270. National League for Nursing
271. National Safety Council
272. Navigate Recovery Gwinnett
273. Nevada Society of Addiction Medicine
274. New Jersey Association of Mental Health and Addiction Agencies, Inc.
275. New Jersey Society of Addiction Medicine
276. New Life Counseling & Wellness Center, Inc.
277. New Mexico Society of Addiction Medicine
278. New York Association of Psychiatric Rehabilitation Services
279. New York Society of Addiction Medicine
280. New York State Council for Behavioral Health
281. NFI Massachusetts, Inc.
282. NMSAS Recovery Center
283. No Health without Mental Health
284. North Charles, Inc.
285. North Cottage Program, Inc.
286. Northeast Center for Youth and Families, The
287. Northern New England Society of Addiction Medicine
288. Northern Ohio Recovery Association (NORA)
289. Northwest Indian Treatment Center
290. North Suffolk Mental Health Association, Inc.
291. Northern Rivers Family Services
292. North Carolina Society of Addiction Medicine (NCSAM)
293. O’Brien House
294. Ohio Society of Addiction Medicine (OHSAM)
295. Oklahoma Citizen Advocates for Recovery & Treatment Association (OCARTA)
296. Old Colony YMCA
297. Open Doorway of Cape Cod
298. Oregon Recovery High School
299. Oregon Society of Addiction Medicine
300. Overcoming Addiction Radio
301. Parity Implementation Coalition
302. Partnership for Drug-Free Kids
303. Partners in Prevention/National Council on Alcoholism and Drug Dependence of Hudson County, Inc.
304. P.E.E.R Wellness Center, Inc.
305. PEER360 Recovery Alliance
306. Pennsylvania Recovery Organization - Achieving Community Together - (PRO-ACT)
307. Pennsylvania Recovery Organizations Alliance (PRO-A)
308. Pennsylvania Society of Addiction Medicine
309. People Advocating Recovery - PAR
310. Phoenix Houses of New England
311. Phoenix Multisport Boston
312. Pine Street Inn
313. Pivot, Alcohol and Substance Abuse Council of Jefferson County, Inc.
314. PLR Athens
315. Pretrial Justice Institute
316. Prevention Network OCAA
317. Psychiatric Rehabilitation Association
318. Putnam Family & Community Services, Inc.
319. RASE Project
320. REAL- Michigan (Recovery, Education, Advocacy & Leadership)
321. Recover Project/Western MA Training
322. Recovery Allies Of West Michigan
324. Recovery Café Seattle
325. Recovery Community Foundation of Forsyth
326. Recovery Communities of North Carolina
327. Recovery Community Of Durham
328. Recovery Consultants of Atlanta
329. Recovery Data Solutions
330. Recovery - Friendly Taos County
331. Recovery Idaho, Inc.
332. Recovery is Happening
333. RecoveryNC (Governors Institute on Substance Abuse)
334. Recovery Point at HER Place
335. Recovery Point of Bluefield
336. Recovery Point of Charleston
337. Recovery Point of Huntington
338. Recovery Point of Parkersburg
339. Recovery Point of West Virginia
340. Recover Wyoming
342. Rhode Island Communities for Addiction Recovery Efforts (RICAREs)
343. Riverside Community Care
344. Robby’s Voice
345. ROCovery Fitness
346. Rockland Council on Alcoholism and Other Drug Dependence, Inc.
347. Sandusky Artisans Recovery Community Center
348. Sandy Hook Promise
349. Serenity Sistas
352. SMART Recovery
353. Solano Recovery Project
354. Solutions Recovery, Inc.
355. Sonoran Prevention Works
356. South Arkansas Regional Health Center, Inc
357. Sound Community Services, Inc.
358. South Middlesex Opportunity Council, Inc. (SMOC)
359. South Bay Community Services
360. South Carolina Society of Addiction Medicine
361. South Central Human Relations Center
362. South End Community Health Center
363. South Shore Mental Health
364. Southwest Washington Recovery Coalition
365. Spectrum Health Systems, Inc.
366. SpiritWorks Foundation
367. Springfield Recovery Community Center
368. Springs Recovery Connection
370. STEP Industries
371. Steppingstone, Incorporated
372. Student Assistance Services Corp
373. Substance Use and Mental Health Leadership Council of Rhode Island
374. Technical Assistance Collaborative, Inc.
375. Tennessee Society of Addiction Medicine
376. Texas Society of Addiction Medicine
377. The Addict’s Parents United (TAP United)
378. The Alliance
379. The Bridge Foundation
380. The Bridge Way School
381. The Campaign for Trauma-Informed Policy and Practice
382. The Chris Atwood Foundation
383. The Council on Alcohol and Drug Abuse
384. The Council on Alcohol & Drug Abuse for Greater New Orleans
385. The DOOR - DeKalb Open Opportunity for Recovery
386. The Global Alliance for Behavioral Health and Social Justice
387. The Kennedy Forum
388. The Ohana Center
389. The Recovery Channel
390. The Rest of Your Life
391. The Trevor Project
392. The Village Family Services
393. The Village Project, Inc.
394. Tia Hart Recovery Community Program
395. T.O.R.C.H Inc.
396. Toward Independent Living and Learning, TILL, Inc.
397. Treatment Communities of America
398. Trilogy Recovery Community
399. Two Guys and a Girl
400. UMass Memorial Community Healthlink, Inc.
401. United Methodist Church - General Board of Church and Society
402. Utah Support Advocates for Recovery Awareness (USARA)
403. Valley Hope
404. Veterans Inc.
405. Vermont Council of Developmental and Mental Health Services
406. Vermont Recovery Network
407. Victory Programs, Inc.
409. Virginia Association of Recovery Residences
410. Voice for Adoption
411. Voices of Hope for Cecil County
412. Voices of Recovery San Mateo County
413. Volunteers of America of Massachusetts, Inc.
414. WAI-IAM, Inc. and RISE Recovery Community
415. Walker, Inc.
416. Washtenaw Recovery Advocacy Project (WRAP)
417. Washington Federation of State Employees
418. Washington Recovery Alliance
419. Washington Society of Addiction Medicine
420. Watershed Treatment Programs
421. Wayside Youth & Family Support Network
423. Wellspring Recovery Services
424. West Virginia Society of Addiction Medicine
425. WholeLife Recovery Community/ Arizona Recovery Coalition
426. Wisconsin Recovery Community Organization (WIRCO)
427. Wisconsin Society of Addiction Medicine
428. Wisconsin Voices for Recovery
429. Wyoming County CARES
430. Yoga of Recovery
431. Young Invincibles
432. Young People in Recovery
433. Young People in Recovery – Los Angeles
434. Youth Opportunities Upheld, Inc.
435. Youth Villages
703.741.7686 x 130
NAADAC, the Association for Addiction Professionals, represents the professional interests of more than 95,000 addiction counselors, educators and other addiction-focused healthcare professionals in the United States, Canada, and abroad. NAADAC’s members are addiction counselors, educators, and other addiction-focused health care professionals, who specialize in addiction prevention, treatment, recovery support, and education. An important part of the healthcare continuum, NAADAC members, and its 47 state affiliates work to create healthier individuals, families and communities through prevention, intervention, quality treatment and recovery support.