Access to Mental Health Care Improved After ACA
Access to healthcare in the United States has improved for adults with moderate and severe mental illness, a new study confirms. Most importantly, researchers note that following pasage of the Patient Protection and Affordable Care Act (ACA), fewer patients with severe mental illness went without mental health care, although gaps in access persist.

Access to healthcare in the United States has improved for adults with moderate and severe mental illness, a new study confirms.

Most importantly, researchers note that following pasage of the Patient Protection and Affordable Care Act (ACA), fewer patients with severe mental illness went without mental health care, although gaps in access persist.

The ACA expanded health insurance to roughly 21 million Americans through insurance reforms, Medicaid expansions, and subsidies for coverage in the marketplace.

The ACA also expanded mental health coverage through mental health parity reforms and through the provision of essential health benefits, which included mental health services. Early ACA-related research found increases in mental health treatment and reductions in the number of uninsured adults with mental illness.

Building on this previous research, Elizabeth Sherrill and Gilbert Gonzales, PhD, from Vanderbilt University School of Medicine in Nashville, Tennessee, examined changes in access to care for adults by mental health status in 2012-2013, before the ACA, and in 2015, after the ACA, using data from the National Health Interview Survey.

The sample included 77,095 adults aged 18 to 64 years (51% women; mean age, 41 years). Using the Kessler 6 (K6) scale, the scores of which range from 0 to 24, with higher scores indicating more severe psychological distress, the study team classified adults as having moderate mental illness (scores from 5 to 12 points), severe mental illness (scores of 13 points or higher) or no mental illness (scores from 0 to 4 points).

In both periods, adults with severe mental illness were more likely to be unemployed, have low income, and have poor or fair health, they report.

After passage of the ACA, and after controlling for sociodemographic factors, there was a decrease in uninsured adults with no mental illness (-6.2 percentage points) and moderate (-8.5 percentage points) and severe mental illness (-9.3 percentage points).

In addition, after the ACA, there was a significant drop in the percentage of adults with moderate mental illness with no usual source of care (-3.5 percentage points), delayed medical care (-4.5 percentage points), forgone medical care (-3.3 percentage points), and forgone prescription medications (-3.6 percentage points).

For adults with severe mental illness, the ACA led to a decrease in forgone prescription medications (-6.8 percentage points) and forgone mental health care (-8.0 percentage points).

The results were published online September 6 in JAMA Psychiatry.

"We did not find improvements in having a usual source of care, delayed medical care because of cost, or seeing a mental health professional for adults with SMI [severe mental illness], which may be attributable to factors not fully addressed by the ACA, such as high cost sharing and continued shortages in mental health," the authors write.

"Future reforms should consider expanding access to care for adults with SMI, with a focus on strengthening the mental health care system," they conclude.

The study had no funding. The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online September 6, 2017. Full text