Individuals with mental illnesses were more likely to have health insurance and be able to access health care and mental health services after the implementation of the Affordable Care Act, according to new research. The gains were present both in states that had expanded Medicaid coverage and those that did not.
Researchers from the University of Kansas, University of North Carolina and the Urban Institute examined the effects of the Affordable Care Act on individuals with mental illnesses by comparing the results of more than 1,500 people with mental health conditions before and after the measure was implemented. The study was authored by Kathleen Thomas of the University of North Carolina, Adele Shartzer of the Urban Institute in Washington, D.C., Noelle Kurth of the Institute for Health and Disability Policy Studies at KU and Jean Hall of KU Medical Center and Institute for Health and Disability Policy Studies. It is published in the journal Psychiatric Services.
Researchers examined information from the Health Reform Monitoring Survey, comparing results from individuals in 2013, and again in 2016, after implementation of the Affordable Care Act. They found that after implementation, people with mental health conditions were less likely to be uninsured—5 percent versus 13 percent in 2013—and to report unmet needs due to the cost of health care, dropping from 21 percent in 2013 to 17 percent in 2016. They were also more likely to report having a usual source of care, by a margin of 82 percent to 76 percent before implementation.
"People in the survey were more likely to receive care, and they were also more likely to report a usual source of care," Hall said, "which is a very important measure of making sure people get the services they need. The Affordable Care Act has been an important way for these individuals to not only gain coverage but to access services."
The Affordable Care Act required that mental health be included in health coverage.
The study did not find that individuals with mental health conditions were more likely to be employed after the ACA, but that measure will be studied in the future. Previous research has shown that individuals with a variety of disabilities were more likely to be employed after gaining coverage in states that expanded Medicaid.
The findings come as the federal government is debating whether to remove the Affordable Care Act's mandate that individuals buy health coverage as part of tax reform. The researchers argue previous work has shown that subsidies are not enough to encourage people to obtain coverage and that uncertainty about changes in the law is already raising concerns among people with mental health conditions about coverage.
"This population may have been eligible for Medicaid coverage all along and not known it. Without the mandate, people will be less likely to buy insurance or see if they qualify," Hall said.
The researchers plan to expand the study next year by conducting a national online survey of people with all types of disabilities to learn how their access to care services, employment and other measures have fared both before and after implementation of the Affordable Care Act, and they will compare those measures to individuals without disabilities.
The findings highlight important improvements in both insurance coverage and care access, both in Medicaid expansion and non-expansion states for people with mental health conditions.
"The Affordable Care Act has been an important way for people with mental health conditions to not only gain coverage but to have access to mental health services," Kurth said. "It helped these individuals live healthy and productive lives."
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