State health care exchanges and Obamacare: Background research on key questions
In January 2014 the majority of the new coverage provisions of the Affordable Care Act (ACA) went into effect. Medicaid eligibility was expanded and private insurers were restricted from increasing prices or excluding individuals from plans because of pre-existing conditions. While the impact of these changes is still being evaluated, earlier provisions of the ACA have clearly been successful: The Dependant Coverage Provision (DCP), enacted in 2010, required insurers to allow children to remain on their parents’ plans up to age 25. This has resulted in major decreases in the number of uninsured young adults in the United States.
Previous research has demonstrated that access to treatment significantly reduces mental health symptoms in the population and increases treatment utilization. This is particularly important given that the U.S. Department of Health and Human Services indicates that many mental health and substance abuse disorders may be especially high during young adulthood.
A 2014 study published in Health Affairs, “An ACA Provision Increased Treatment for Young Adults With Possible Mental Illnesses Relative to Comparison Group,” sought to examine differences in mental health treatment utilization among adults aged 19 to 25 who may have mental health or substance abuse disorders following the DCP’s implementation. The researchers — Brendan Salonera of the Johns Hopkins Bloomberg School of Public Health and Benjamin Lê Cook of Harvard Medical School/Cambridge Health Alliance — based their work on the 2008-2012 National Surveys on Drug Use and Health. Because the data did not specify the subjects’ precise year of birth, the authors included adults aged 18 to 25 in their sample; however, this inclusion would tend to under- rather than over-estimate the provision’s effect. This cohort’s treatment utilization before and after the DCP was implemented was compared observed rates among 26-35 year olds, for whom the DCP did not apply.
The paper’s findings include:
- Among 18- to 25-year-olds with possible mental disorders, use of any mental health treatment following the implementation of the DCP increased by 2.16 percentage points. Over the same period, the usage rate among 26- to 35-year-olds decreased by 3.16 percentage points.
- After the DCP came into force, the proportion of 18- to 25-year-olds who used private insurance during their last treatment episode increased by 3.84 percentage points. By comparison, the rate among 26- to 35-year-olds during the same period fell by 9.1 percentage points.
- The proportion of 18- to 25-year-olds who were uninsured during their last treatment episode decreased by 2.88 percentage points. For those aged 26 to 35, the proportion of those without insurance rose 9.75 percentage points.
- There were no significant differences in the changes in substance-abuse treatment before and after the DCP between 18- to 25-year-olds and 26- 35-year-olds.
“The ACA dependent-coverage provision appears to be a stepping-stone toward increasing mental health treatment among young adults with possible mental health problems,” the researchers conclude. “The act may also improve the comprehensiveness of substance abuse coverage for young adults with substance use disorders.” However, they caution that the study design could not account for factors external to the DCP, including the economic downturn.
Related research: A 2012 study published in Health Services Research showed that the rate of uninsured young adults decreased substantially following the implementation of the DCP. A 2014 research brief from U.C. San Diego described how state decisions on expanding Medicaid influence the success of insurance marketplaces. A 2014 study in the Annals of Internal Medicine showed decreases in mortality after Massachusetts’ implementation of health care reform. A 2014 research review looks at state health care exchanges, while a 2013 study for the National Bureau of Economic Research showed that increased access to contraceptives is associated with decreases in unwanted or ill-timed births, increases in family incomes, and increases in education of offspring.
Keywords: mental health, mental illness, substance use, substance abuse, drug use, drug abuse, Affordable Care Act, Dependence Coverage Provision, young adults, insurance, Medicaid,