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Mental health care coverage increases following ACA expansion
Following Affordable Care Act expansions in 2014, insurance coverage and mental health treatment increased among individuals with mental and substance use disorders; however, use of substance use disorder treatment did not.
“The Affordable Care Act has been very effective in reducing the uninsured rate in this vulnerable population where there is a real need to get people into services,” Brendan Saloner, PhD, of Johns Hopkins Bloomberg School of Public Health, said in a press release. “But having insurance is just the first step. We need to find ways to get this population treated, whether that means prescriptions for psychotropic drugs, counseling or placements in drug treatment programs.”
To assess changes in coverage and treatment use after ACA insurance expansions in 2014, researchers analyzed data from the National Survey on Drug Use and Health for individuals aged 18 to 64 years who screened positive for any mental health disorder (n = 29,962) or substance use disorder (n = 19,243) from 2011 to 2013 or in 2014.
Uninsured rates for individuals with mental disorders (–5.4 percentage points; P < .01) and substance use disorders (–5.1 percentage points; P < .01) significantly decreased in 2014, compared with 2011 to 2013.
Most increases in insurance coverage were due to Medicaid.
Increases in coverage were larger among adults with incomes 200% or lower of the federal poverty line, compared with all other study participants.
Use of mental health treatment increased by 2.1 percentage points (P = .04), but there was no change in use of substance use disorder treatment.
Treatment settings for mental and substance use disorder treatments did not significantly change.
Payment via Medicaid for substance use disorder treatment increased by 7.4 percentage points (P = .05).
“We got more people covered, but we didn’t make dramatic progress in closing the under-treatment gap. We need to find ways to take the next step and ensure people are seeing the providers who can help them,” Saloner said in the release. “2017 is not likely to be a year when additional states opt to expand their Medicaid programs. Instead, it could be a year of massive retraction. Loss of insurance would surely be a step backward for people with mental illness and substance use disorders.” – by Amanda Oldt
Disclosure: The researchers reported no relevant financial disclosures.