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Health care access increases post-ACA for adults with mental illness

From 2012 to 2015, access to health care increased among adults with moderate or severe mental illness, according to recent findings.

“The Patient Protection and Affordable Care Act (ACA) expanded health insurance to approximately 21 million Americans through health insurance reforms (eg, guaranteed issue, adjusted community rating, preexisting condition exclusion bans, and dependent coverage extensions), expansions in Medicaid, and subsidies for marketplace coverage,” Elizabeth Sherrill, BS, and Gilbert Gonzales, PhD, MHA, study researchers from Vanderbilt University School of Medicine, wrote. “The ACA also expanded mental health coverage through mental health parity reforms and the provision of essential health benefits, which include mental health services. Early ACA-related research found increases in mental health treatment and reductions in uninsured adults with mental illness.”

To evaluate changes in access to care for adults by mental health status, researchers analyzed data from the 2012, 2013 and 2015 National Health Interview Survey for a nationally representative cohort of 77,095 adults aged 18 to 64 years (mean age, 40.7 years).

After controlling for sociodemographic factors, uninsured participants with no mental illness decreased by 6.2 percentage points (95% CI, –7 to –5.5); uninsured participants with moderate mental illness decreased by 8.5 percentage points (95% CI, –10.3 to –6.8); and uninsured participants with serious mental illness decreased by 9.3 percentage points (95% CI, –13.1 to –5.5).

Having no usual source of care (3.5 percentage points; 95% CI, 5.3 to 1.6), delayed medical care (4.5 percentage points, 95% CI, 6.2 to 2.8), forgone medical care (3.3 percentage points, 95% CI, 5 to 1.6) and forgone prescription medications (3.6 percentage points; 95% CI, 5.4 to 1.9) significantly decreased among participants with moderate mental illness.

Among adults with serious mental illness, forgone prescription medications (6.8 percentage points; 95% CI, 11.5 to 2) and forgone mental health care (8 percentage points; 95% CI, 11.7 to 4.3) decreased.

“Access to care has improved for adults with [moderate mental illness] and [serious mental illness] in recent years. Of importance, forgone mental health care decreased significantly for individuals with [serious mental illness]. However, gaps in access persist,” the Sherrill and Gonzales wrote. “We did not find improvements in having a usual source of care, delayed medical care because of cost, or seeing a mental health professional for adults with [serious mental illness], which may be attributable to factors not fully addressed by the ACA, such as high cost sharing and continued shortages in mental health.” – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.