alcohol and other drug screening and brief
intervention services.^120 Although 76 percent of
smokers in commercial health plans reported
being advised by their physician to stop smoking
in a 2008 survey; only half recalled being
advised about smoking cessation strategies or
medications.^121
The ACA was designed to increase the number
of individuals covered under Medicaid and
commercial insurance,* 122 but also allows states
facing budget deficits to scale back eligibility
under certain circumstances.† 123 Because of
economic constraints, states appear to be cutting
back on health services rather than assuring
access to these services.‡ 124
An additional resource problem that stands in
the way of screening and early interventions is a
legal statute dating back to 1947, the Uniform
Accident and Sickness Policy Provision Law
(UPPL).^125 Under the UPPL, insurers can deny
payment for treatment of injuries sustained by a
person under the influence of alcohol or other
drugs.§ 126 In states that adopted UPPL, EDs and
trauma centers might not screen for risky
substance use because reimbursement for the
emergency or trauma services they provide
could be denied; as a result, critical
opportunities for intervention are missed.^127
Because of the barriers the UPPL imposes to
- The ACA mandates no co-pay in private insurance
and self-insured plans for alcohol screening and
counseling; alcohol and other drug use assessments
for adolescents; tobacco use screening for all adults;
and cessation interventions for tobacco users.
† States are permitted to scale back eligibility if they
have expanded their Medicaid programs to non-
pregnant, non-disabled adults with incomes over 133
percent of the poverty level.
‡ At least 31 states have implemented cuts that will
restrict eligibility for health insurance programs
and/or access to health care services.
§ The law originally was adopted to control insurance
costs at a time when little knowledge was available
about addiction and when access to treatment was
limited. The statute states: “The insurer shall not be
liable for any loss sustained or contracted in
consequence of the insured’s being intoxicated or
under the influence of any narcotic unless
administered on the advice of a physician.”
needed screening and interventions for risky
substance use, the AMA has been working to
overturn the law and prohibit other state laws
modeled on it.** 128 As of January 2011, 25
states still have the UPPL or a history of court
decisions that permit insurers to use an alcohol
exclusion to deny payment for treatment; 16
states and the District of Columbia prohibit
denial of benefits.†† 129 A similar legal provision
allows many states to deny disability payments
or workers’ compensation to individuals harmed
while under the influence of alcohol or while
participating in an illegal act, such as driving
under the influence.^130Treatment for Addiction. Current coverage of
addiction treatment is not designed to prevent
and treat the disease effectively. There is
considerable variability in coverage within and
among public and private insurance plans which
poses significant barriers to treatment
accessibility.Medicaid. The Medicaid program is the major
public health coverage program for low-income
Americans.^131 With the exception of the ACA’s
“essential health benefits” requirement,‡‡
addiction treatment services are not federally
mandated in Medicaid,^132 nor are any addiction
treatment services that are eligible for
reimbursement defined at the federal level.^133
However, states may provide addiction-related
services under several of the mandatory benefit
categories: Physician services;^134 Inpatient services provided in a general
hospital, such as inpatient detoxification,^135
but not including room and board charges in** In 2001, the National Association of Insurance
Commissioners, which originally adopted the UPPL
as a model law in 1947 and encouraged states to
implement it, reversed their position and
recommended the repeal of the UPPL. Since that
time, several organizations along with the AMA have
pledged support for repealing the UPPL.
†† Other states do not explicitly permit or prohibit
alcohol exclusion provisions.
‡‡ Applies to Medicaid benchmark/equivalent plans.