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Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders.
Psychiatr Serv. 2017 Jun 01; 68(6):542-548.PS

Abstract

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 (-5.4 percentage points, p<.01) and substance use disorders (-5.1 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.

Authors+Show Affiliations

Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28093059

Citation

Saloner, Brendan, et al. "Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders." Psychiatric Services (Washington, D.C.), vol. 68, no. 6, 2017, pp. 542-548.
Saloner B, Bandara S, Bachhuber M, et al. Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders. Psychiatr Serv. 2017;68(6):542-548.
Saloner, B., Bandara, S., Bachhuber, M., & Barry, C. L. (2017). Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders. Psychiatric Services (Washington, D.C.), 68(6), 542-548. https://doi.org/10.1176/appi.ps.201600182
Saloner B, et al. Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders. Psychiatr Serv. 2017 Jun 1;68(6):542-548. PubMed PMID: 28093059.
* Article titles in AMA citation format should be in sentence-case
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, Y1 - 2017/01/17/ PY - 2017/1/18/pubmed PY - 2018/3/24/medline PY - 2017/1/18/entrez KW - Affordable Care Act KW - Medicaid KW - access to care KW - insurance KW - mental health KW - substance use disorders SP - 542 EP - 548 JF - Psychiatric services (Washington, D.C.) JO - Psychiatr Serv VL - 68 IS - 6 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 (-5.4 percentage points, p<.01) and substance use disorders (-5.1 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. SN - 1557-9700 UR - https://www.unboundmedicine.com/medline/citation/28093059/Insurance_Coverage_and_Treatment_Use_Under_the_Affordable_Care_Act_Among_Adults_With_Mental_and_Substance_Use_Disorders_ L2 - https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600182?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -