ACA Made it Possible for More with Mental Health Problems to Get Care
November 27, 2017 | By Rose Hoban
People who cope with mental health issues ranging from mild to severe were more likely to get treatment in the wake of the Affordable Care Act, according to a study led by a health economist from UNC Chapel Hill.
The report, published this month in the journal Psychiatric Services, found that in the years since implementation of the ACA (often called Obamacare), people with mental health issues, including anxiety, depression, bipolar disorder or schizophrenia, were more likely to have a regular doctor and were less likely to skip health care and mental health care because of the expense.
According to UNC health economist, Kathleen C. Thomas, who led the analysis, the findings applied to people in states that expanded Medicaid and states such as North Carolina that chose not to extend the program to lower-income residents.
Thomas, who works at the Sheps Center for Health Services Research, said that the improvement was, in part, because of the improved insurance quality standards created under the ACA. The law defined a package of “essential health benefits” all new insurance policies were required to meet, which included access to mental health services.
“Our findings have to do more with improved quality of the insurance that people did have,” she said in an interview. “These findings underscore some of the importance of the standards laid out in the policy.”
From a panel of more than 47,000 people interviewed before implementation of the law and then at several points afterward the researchers examined questions about people’s access to care and whether they had regular health care providers. Compared to before implementation of the law, people with mental health problems were more likely to have “a usual source of care” and were less likely to have “unmet need for mental health care (unaffordable).”
“Less than half the population of people with diagnosed problems have access to any mental health care,” said Thomas, who noted in the paper that prior research has found only 41 percent of people with mental health disorders use any services.
People with mental health issues “carry a significant burden of chronic illness and early mortality,” Thomas said. Research has shown that people with mental health issues are twice as likely to have a chronic disease and to die young.
“Increasing insurance and access to care for these people are significant policy achievements,” she said.
Thomas and her co-authors also found that people with mental health issues were slightly more likely to be employed after implementation of the ACA than before.
“There is evidence that people receiving comprehensive care can improve mental health functioning and, subsequently, their rates of employment,” the authors said.
She noted that in the run-up to the ACA going into effect, critics said people would be more likely to quit their jobs in order to get onto Medicaid, or that workers would end up with reduced hours at their jobs because employers did not want to cover their full-time workers.
But that wasn’t what the data showed.
“The health improvements that people with mental health conditions may enjoy as a result of improved access to care may result in improved employment outcomes over time,” they wrote.