Abstract
The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014–2016, but gaps remain.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Akosa Antwi, Y., Moriya, A. S., & Simon, K. I. (2015). Access to health insurance and the use of inpatient medical care: evidence from the Affordable Care Act young adult mandate. Journal of Health Economics, 39, 171–187. https://doi.org/10.1016/j.jhealeco.2014.11.007.
Ali, M. M., Chen, J., Mutter, R., Novak, P., & Mortensen, K. (2016a). The ACA’s dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions. Psychiatric Services. https://doi.org/10.1176/appi.ps.201500346.
Ali, M. M., Teich, J., Woodward, A., & Han, B. (2016b). The implications of the affordable care act for behavioral health services utilization. Administration and Policy in Mental Health and Mental Health Services Research Adm Policy Ment Health, 43(1), 11–22. https://doi.org/10.1007/s10488-014-0615-8.
Ali, M. M., Teich, J. L., & Mutter, R. (2015). The role of perceived need and health insurance in substance use treatment: implications for the Affordable Care Act. Journal of Substance Abuse Treatment, 54, 14–20. https://doi.org/10.1016/j.jsat.2015.02.002.
Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the united states. The Milbank Memorial Fund Quarterly. Health and Society, 51(1), 95. https://doi.org/10.2307/3349613.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1. https://doi.org/10.2307/2137284.
Assistant Secretary for Planning and Evaluation. (2013). The Feasibility Of Using Electronic Health Data for Research on Small Populations Coverage of Asian-American Subpopulations in Federal Data Collection. Retrieved December 3, 2017, from https://aspe.hhs.gov/report/feasibility-using-electronic-health-data-research-small-populations/coverage-asian-american-subpopulations-federal-data-collection.
Avery, K., Gardner, M., Gee, E., Marchetti-Bowick, E., McDowell, A., Sen, A. Health plan choice and premiums in the 2016 Health Insurance Marketplace. (2015). Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. Retrieved 24 May, 2017 from https://aspe.hhs.gov/pdf-report/health-plan-choice-and-premiums-2016-health-insurance-marketplace.
Baicker, K., & Finkelstein, A. (2011). The effects of medicaid coverage—learning from the oregon experiment. New England Journal of Medicine N Engl J Med, 365(8), 683–685. https://doi.org/10.1056/nejmp1108222.
Bustamante, A. V., Fang, H., Rizzo, J. A., & Ortega, A. N. (2009). Understanding observed and unobserved health care access and utilization disparities among U.S. Latino adults. Medical Care Research and Review, 66(5), 561–577. https://doi.org/10.1177/1077558709338487.
Carman, K. G., Eibner, C., & Paddock, S. M. (2015). Trends in health insurance enrollment. 2013–15 Health Affairs, 34(6), 1044–1048. https://doi.org/10.1377/hlthaff.2015.0266.
Centers for Disease Control/National Center for Health Statistics. 2015 Data Release Imputed Income Files. Retrieved December 1, 2017, from https://www.cdc.gov/nchs/nhis/nhis_2015_data_release.htm.
Chen, J., Bustamante, A. V., & Tom, S. E. (2015). Health care spending and utilization by race/ethnicity under the Affordable Care Act’s dependent coverage expansion. American Journal of Public Health, https://doi.org/10.2105/ajph.2014.302542.
Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical Care, 54(2), 140–146. https://doi.org/10.1097/mlr.0000000000000467.
Cohen, R., & Zammitti, E. (2016). Access to care among adults aged 18–64 with serious psychological distress: Early release of estimates from the National Health Interview Survey, 2012–September 2015. National Center for Health Statistics, Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/er_spd_access_2015_f_auer.pdf .
Cook, B. L., Zuvekas, S. H., Chen, J., Progovac, A., & Lincoln, A. K. (2016). Assessing the individual, neighborhood, and policy predictors of disparities in mental health care. Medical Care Research and Review. https://doi.org/10.1177/1077558716646898.
Creedon, T. B., & Cook, B. L. (2016). Access to mental health care increased but not for substance use, while disparities remain. Health Affairs (Millwood), 35(6), 1017–1021. https://doi.org/10.1377/hlthaff.2016.0098.
Croft, B., & Parish, S. L. (2012). Care integration in the Patient Protection and Affordable Care Act: Implications for behavioral health. Administration and Policy in Mental Health and Mental Health Services Research, 40(4), 258–263. https://doi.org/10.1007/s10488-012-0405-0.
Cutler, D. M. (2015). From the Affordable Care Act to affordable care. JAMA, 314(4), 337. https://doi.org/10.1001/jama.2015.7683.
Gonzales, G., Golberstein, E., Hill, S. C., & Zuvekas, S. H. (2016). Psychological distress and enrollment in medicaid. J Behav Health Serv Res. https://doi.org/10.1007/s11414-016-9532-9.
Han, B., Gfroerer, J., Kuramoto, S. J., Ali, M., Woodward, A. M., & Teich, J. (2015). Medicaid expansion under the Affordable Care Act: potential changes in receipt of mental health treatment among low-income nonelderly adults with serious mental illness. American Journal of Public Health, 105(10), 1982–1989. https://doi.org/10.2105/ajph.2014.302521.
Kessler, R., Andrews, G., Colpe, L., Hiripi, E., Mroczek, D., Normand, S.,…Zaslavsky, A. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32(6), 959–976. https://doi.org/10.1017/s0033291702006074.
Long, S. K., Stockley, K., & Dahlen, H. (2012). Massachusetts health reforms: Uninsurance remains low, self-reported health status improves as state prepares to tackle costs. Health Affairs, 31(2), 444–451. https://doi.org/10.1377/hlthaff.2011.0653.
Majerol, M., Newkirk, V., & Garfield, R. (2015). The uninsured: A Primer. Retrieved from http://kff.org/uninsured/report/the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-era-of-health-reform/.
Mark, T. L., Olesiuk, W., Ali, M. M., Sherman, L. J., Mutter, R., & Teich, J. L. (2017). Differential reimbursement of psychiatric services by psychiatrists and other medical providers. Psychiatric Services. https://doi.org/10.1176/appi.ps.201700271.
Mechanic, D. (2012). seizing opportunities under the affordable care act for transforming the mental and behavioral health system. Health Affairs, 31(2), 376–382. https://doi.org/10.1377/hlthaff.2011.0623.
Moffitt, R., Schoeni, R. F., Brown, C., Chase-Lansdale, P. L., Couper, M. P., Diez-Roux, A. V.,… Seltzer, J. A. (2015). Assessing the need for a new nationally representative household panel survey in the United States Journal of Economic and Social Measurement, 40(1–4), 1–26. https://doi.org/10.3233/JEM-150411.
Novak, P., Williams-Parry, K. F., & Chen, J. (2016). Racial and ethnic disparities among the remaining uninsured young adults with behavioral health disorders after the aca expansion of dependent coverage. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-016-0264-6.
Prochaska, J. J., Sung, H.-Y., Max, W., Shi, Y., & Ong, M. (2012). Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. International Journal of Methods in Psychiatric Research, 21(2), 88–97. https://doi.org/10.1002/mpr.1349.
Saloner, B., Bandara, S., Bachhuber, M., & Barry, C. L. Insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders. Psychiatric Services. 2017;https://doi.org/10.1176/appi.ps.201600182.
Scott, J. W., Sommers, B. D., Tsai, T. C., Scott, K. W., Schwartz, A. L., & Song, Z. (2015). Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients. Health Affairs (Millwood), 34(1), 125–133.
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA, 314(4), 366. https://doi.org/10.1001/jama.2015.8421.
Substance Abuse Mental Health Services Administration. (2017). Integrating Behavioral Health Into Primary Care. Retrieved 1 May, 2017 from http://www.integration.samhsa.gov/integrated-care-models/behavioral-health-in-primary-care.
Wherry, L. R., & Miller, S. (2016). Early coverage, access, utilization, and health effects associated with the Affordable Care Act medicaid expansions. Annals of Internal Medicine, 164(12), 795. https://doi.org/10.7326/m15-2234.
Funding
Funding was provided by National Institute of Mental Health (Grant No. R01MD011523).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ms. Novak was an employee of the Agency for Healthcare Research and Quality at the time this manuscript was prepared. The views expressed in this manuscript are those of the authors who are solely responsible for the content. The views in this manuscript do not represent those of the US Government, the Department of Health and Human Services, or the Agency for Healthcare Research and Quality. Mr. Anderson has nothing to disclose. Dr. Chen has nothing to disclose.
Rights and permissions
About this article
Cite this article
Novak, P., Anderson, A.C. & Chen, J. Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act. Adm Policy Ment Health 45, 924–932 (2018). https://doi.org/10.1007/s10488-018-0875-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-018-0875-9