Affordable Care Act provisions reduced percentage of uninsured people with schizophrenia

The percentage of those with schizophrenia who were uninsured decreased after the Affordable Care Act provisions were implemented, researchers reported in JAMA Psychiatry.

“Schizophrenia impacts 0.25% to 0.64% of people in the U.S. and is associated with comorbid diseases, reduced life expectancy and substantial health care costs. Health insurance is critically important to ensure adequate health care access for ongoing treatment of psychiatric and medical needs,” Kimberley H. Geissler, PhD, of the University of Massachusetts Amherst School of Public Health and Health Sciences, and colleagues wrote.

According to Geissler and colleagues, research before the implementation of the Patient Protection and ACA showed that 12% of those with schizophrenia were annually uninsured. Studies conducted after the passage of the ACA have shown high rates of transitions between insurance types for young adults with schizophrenia.

Geissler and colleagues used the Medical Expenditure Panel Survey from 2008 to 2020 to identify those with schizophrenia. The authors calculated descriptive statistics for the sample to assess differences in pre-ACA compared with post-ACA periods. Then, the authors calculated probabilities of insurance coverage using a logistic regression analysis.

In total, the sample included 9,173,644 individuals with schizophrenia (57.4% male; mean age, 44 years).

Regression-adjusted analyses showed a significant reduction in the percentage of uninsured after the implementation of the ACA, compared with prior (8.4% vs. 4%; difference, –4.5 percentage points; 95% CI, –8.3 to –0.6). In addition, there was a corresponding increase in coverage by Medicaid (difference, 8.7 percentage points; 95% CI, 0.3-17.1) and Medicare (difference, 5 percentage points; 95% CI, –4.3 to 14.3).

“Following implementation of ACA provisions, the percentage of individuals with schizophrenia who were uninsured declined, accompanied by a rise in Medicaid coverage,” Geissler and colleagues wrote. “Of people with schizophrenia, 4% remained uninsured after the ACA.”