TY - JOUR
T1 - Insurance coverage and treatment use under the affordable care act among adults with mental and substance use disorders
AU - Saloner, Brendan
AU - Bandara, Sachini
AU - Bachhuber, Marcus
AU - Barry, Colleen L.
N1 - Publisher Copyright:
© Copyright American Psychiatric Association. All rights reserved.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Objective: Many adults who have mental or substance use disorders or both experience insurance-related barriers to care, contributing to low treatment utilization. Expanded insurance under the Affordable Care Act (ACA) could improve coverage and access. The study identified changes in coverage and treatment use following 2014 ACA insurance expansions. Methods: Data from the National Survey on Drug Use and Health were used to identify individuals ages 18-64 screening positive for any mental disorder (N=29,962) or substance use disorder (N=19,243) for two periods: 2011-2013 and 2014. Regression-adjusted means were calculated for insurance rates and treatment used in each period overall and among individuals with household incomes #200% of the federal poverty level (FPL). Results: Compared with 2011-2013, in 2014 significant reductions were seen in the uninsured rate for individuals with mental disorders (25.4 percentage points, p,.01) and substance use disorders (25.1 percentage points, p,.01). Increases in insurance coverage occurred mostly through Medicaid. Insurance gains were larger for adults with incomes #200% of FPL compared with the overall sample. Use of mental health treatment increased by 2.1 percentage points (p=.04), but use of substance use disorder treatment did not change. No significant changes were noted in treatment settings for mental and substance use disorder treatments. Payment by Medicaid for substance use disorder treatment increased by 7.4 percentage points (p=.05). Conclusions: Sizable increases in coverage for adults with mental disorders and adults with substance use disorders were identified in the year following the 2014 ACA expansions; however, low treatment rates among this population remain a concern. Initiatives to engage the newly insured in treatment are needed.
AB - Objective: Many adults who have mental or substance use disorders or both experience insurance-related barriers to care, contributing to low treatment utilization. Expanded insurance under the Affordable Care Act (ACA) could improve coverage and access. The study identified changes in coverage and treatment use following 2014 ACA insurance expansions. Methods: Data from the National Survey on Drug Use and Health were used to identify individuals ages 18-64 screening positive for any mental disorder (N=29,962) or substance use disorder (N=19,243) for two periods: 2011-2013 and 2014. Regression-adjusted means were calculated for insurance rates and treatment used in each period overall and among individuals with household incomes #200% of the federal poverty level (FPL). Results: Compared with 2011-2013, in 2014 significant reductions were seen in the uninsured rate for individuals with mental disorders (25.4 percentage points, p,.01) and substance use disorders (25.1 percentage points, p,.01). Increases in insurance coverage occurred mostly through Medicaid. Insurance gains were larger for adults with incomes #200% of FPL compared with the overall sample. Use of mental health treatment increased by 2.1 percentage points (p=.04), but use of substance use disorder treatment did not change. No significant changes were noted in treatment settings for mental and substance use disorder treatments. Payment by Medicaid for substance use disorder treatment increased by 7.4 percentage points (p=.05). Conclusions: Sizable increases in coverage for adults with mental disorders and adults with substance use disorders were identified in the year following the 2014 ACA expansions; however, low treatment rates among this population remain a concern. Initiatives to engage the newly insured in treatment are needed.
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U2 - 10.1176/appi.ps.201600182
DO - 10.1176/appi.ps.201600182
M3 - Article
C2 - 28093059
AN - SCOPUS:85020279846
SN - 1075-2730
VL - 68
SP - 542
EP - 548
JO - Psychiatric Services
JF - Psychiatric Services
IS - 6
ER -