A new study led by a UNC professor found that people with mental health conditions are more likely to be insured and receive sufficient, affordable care for their mental needs since the implementation of the Affordable Care Act.
Kathleen Thomas, senior research fellow at the Cecil G. Sheps Center for Health Services Research, led the study. She found that after the ACA’s implementation, people with mental illness were more likely to be insured, less likely to report unmet need due to cost and more likely to report a full source of care.
Thomas said that these findings point to the importance of insurance quality standards set by the ACA for all insurers. These standards include not allowing insurers to deny purchase of insurance based on pre-existing conditions. The ACA also defines “essential health benefits” that all policies must cover. These essential health benefits include mental health services, and specify that mental health must be considered a general health service.
“For people with mental health conditions, they have extremely low rates of service use,” Thomas said. “Less than half of people with mental disorders use any mental health services. They have high chronic illness and early mortality rates. So these changes are really a significant policy achievement.”
The study also compared the changes in states that chose to expand Medicaid, a social health care program for individuals with limited income, and those that did not. Thomas said the expansion states saw greater advancement in quality and availability of care. She noted that both expansion and non-expansion states saw overall improvement, a fact she feels further underscores the importance of the quality standards set by the ACA.
Marisa Domino, director of the Program on Mental Health and Substance Abuse Systems and Services at the Sheps Center, spoke of the importance of patient centered medical homes, a model of care she has studied that is promoted under the ACA. This model looks to make typical primary care practices more accessible to patients by using teams of health care providers as opposed to a single provider, among other improvements.
“In those studies on people with severe mental illness who are enrolled in the Medicaid program, we do find that having a provider who takes the form of a patient centered medical home does increase access to care and some of the quality of care measures that we’ve looked at,” Domino said.
Jean Hall, professor of health policy and management at the University of Kansas, worked on the study with Thomas. She said they have seen indications of these medical care improvements leading to higher levels of employment in disabled populations. In future studies, Hall thinks they will be able to identify these changes in the mental health population specifically.
“What we think is there was probably a lot of pent-up need, meaning they weren’t getting these services before and now they are,” Hall said. “It’s going to take them a little while to get stabilized. And if we do this study in six months or a year, we may see that their employment increased as well.”
