the impact of national health reform on adults with mental disorders
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The Impact of National Health Reform on Adults with Mental Disorders. Rachel L. Garfield, Ph.D. Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health Samuel H. Zuvekas, Ph.D. Agency for Healthcare Research & Quality Judith R. Lave, Ph.D. - PowerPoint PPT PresentationTRANSCRIPT
The Impact of National Health Reform on The Impact of National Health Reform on Adults with Mental DisordersAdults with Mental Disorders
Rachel L. Garfield, Ph.D.Rachel L. Garfield, Ph.D.Department of Health Policy & Management, Department of Health Policy & Management,
University of Pittsburgh Graduate School of Public HealthUniversity of Pittsburgh Graduate School of Public Health
Samuel H. Zuvekas, Ph.D.Samuel H. Zuvekas, Ph.D.Agency for Healthcare Research & QualityAgency for Healthcare Research & Quality
Judith R. Lave, Ph.D.Judith R. Lave, Ph.D.Julie Donohue, Ph.D.Julie Donohue, Ph.D.
Department of Health Policy & Management, Department of Health Policy & Management, University of Pittsburgh Graduate School of Public HealthUniversity of Pittsburgh Graduate School of Public Health
Background
Insurance coverage important determinant of Insurance coverage important determinant of access to mental health treatment access to mental health treatment (Landerman et al 1994, Zuvekas 1999, (Landerman et al 1994, Zuvekas 1999, McAlpine and Mechanic 2000, Kessler et al. McAlpine and Mechanic 2000, Kessler et al. 2005, Roy-Byrne et al 2009) 2005, Roy-Byrne et al 2009)
Potential for significant impact of the Patient Potential for significant impact of the Patient Protection and Affordable Care Act of 2010 on Protection and Affordable Care Act of 2010 on individuals with mental disorders:individuals with mental disorders:– <133 % of Federal Poverty Line (FPL) eligible for <133 % of Federal Poverty Line (FPL) eligible for
MedicaidMedicaid– 133-400% of FPL eligible for exchange subsidies133-400% of FPL eligible for exchange subsidies– Parity in Mental Health CoverageParity in Mental Health Coverage
Objectives
Examine current sources of insurance coverage and use of mental health services among adults with mental disorders
Simulate post-reform changes:– health insurance coverage – mental health treatment use
Data Source: MEPS
Medical Expenditure Panel Survey (2004-2006)– Large nationally, representative survey
– Key variables: Health insurance coverage Family income and poverty status Mental health treatment use Mental health status
– Pooled to increase precision N=51,080 adults aged 18-64
Data: Key Variables
Mental Health Status (Adult SAQ)– PHQ-2 2-Item Depression Screener
(PHQ-2>=3)
– K6 General Psychological Distress (K6>=13)
Family Income– Based on Health Insurance Eligibility Units
– <133%,133-400%, 400+ of poverty
Data: Key Variables (cont)
Health Insurance Coverage– Medicare (including duals)
– full year private
– full year Medicaid
– uninsured part-year
– uninsured full year
Mental Health Treatment Use– Any inpatient, hospital outpatient, ED, office
or clinic visit, or prescription drug fill for mental health reason
Post-Reform Simulation: Insurance Coverage
Apply CBO assumptions on takeup rates: – 59% decrease overall in the uninsured
– <133% of FPL uninsured switch to Medicaid
– >133% of FPL uninsured switch into Private coverage.
– Enrollment in Medicare stable
Post-Reform Simulation: Mental Health Treatment Use
Regression model of the impact of health insurance coverage on use of treatment:– Logistic regression
– Controls for age, race/ethnicity, sex, education, region and MSA, family income, insurance status, mental health status, physical health status, attitudes and preferences towards insurance and health care
Will apply CBO assumptions on take-up rates
Distribution of Adults 18-64 by Poverty Status
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
<133 % FPL 133-400% FPL >400% FPL
% of Total
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Distribution of Adults 18-64 by Health Insurance Status
0
10
20
30
40
50
60
70
Medicare Private Medicaid Uninsuredpart year
Uninsuredfull-year
% of Total
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Distribution of Adults 18-64 <133% FPL by Insurance
05
1015202530354045
Medicare Private Medicaid Uninsuredpart year
Uninsuredfull-year
% of Total
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Distribution of Adults 18-64 133-400% FPL by Insurance
0
10
20
30
40
50
60
70
Medicare Private Medicaid Uninsuredpart year
Uninsuredfull-year
% of Total
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Use of Mental Health Services Use of Mental Health Services Among Adults 18-64Among Adults 18-64
48%
22%
37%38%
64%
5%
10%
16%12%
37%
0%
10%
20%
30%
40%
50%
60%
70%
Medicare Private Medicaid Uninsuredpart year
Uninsuredfull-year
% with Use
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Figure 2
Simulated Post-Reform Health Insurance Coverage of Currently Uninsured Nonelderly
Adults by Mental Health Status
31.2%21.7%
22.2%29.8%
40.8% 40.8%
4.5%3.4%
3.2%2.4%
Depression or Serious
Psychological Distress
No Depression or Serious
Psychological Distress
Total = 6.3 Million Total = 46.7 Million
Source: Authors’ analysis based on CBO projections and MEPS coverage and income data.
Employer
Medicaid
Uninsured
Exchange
Non -group/other
Employer
Medicaid
Uninsured
Exchange
Non -group/other
Figure 2
Figure 3
Simulated Impact of Reform on Health Insurance Coverage of Nonelderly Adults with Depression
or Serious Psychological Distress
11.3% 11.3%
13.1%24.6%
48.7%
16.2%
6.7%21.0%8.7%
38.4%
Pre-Reform Post-Reform
Private
Medicaid
Uninsured part year
Uninsured full year
Note: Dual eligibles are included in Medicare.Source: Authors’ analysis based on CBO projections and MEPS coverage and income data.
Medicare
Private
Medicaid
Uninsured part year
Uninsured full year
Medicare
Figure 3
Simulated Impact of Reform on Mental Health Service Use: Uninsured <133% FPL
45%
23%
13%
5%
0%5%
10%15%20%25%30%35%40%45%50%
Pre-Reform (Uninsured) Post-Reform (Medicaid)
% with Use
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Simulated Impact of Reform on Mental Health Use: Uninsured 133-400% FPL
34%
17%
8%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Pre-Reform (Uninsured) Post-Reform (Private)
% with Use
Depression or Serious Psychological DistressNo Depression or Serious Psychological Distress
Summary
Adults with mental disorders have lower incomes and are more likely to be uninsured than their counterparts
Adults with mental disorders are significantly more likely to be enrolled in Medicare and/or Medicaid than those without
Only one-quarter of individuals with mental disorders who lack insurance coverage for the full year had any mental health service use in 2004-2006 compared to approximately half of those with coverage
After reform is fully implemented, we estimate 3.7 million currently uninsured individuals with mental disorders will gain coverage, with approximately one-third covered under Medicaid
We estimate that use of mental health treatment could double among those previously uninsured
Implications
Health reform is likely to have a significant impact on coverage and use of services among adults with mental disorders. – Will depend on implementation and capacity of
mental health system to absorb increased demand
Public insurance programs that currently play a major role in financing mental health services will play an even greater role post-reform