Insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders
Open accessAbstract
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.
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Access to services is still a major problem.
“But access to services remains a major concern (Feder et al., 2017; Saloner et al., 2017), and much is still unknown regarding how ACA-associated enrollment through insurance exchanges and cost-sharing structures (especially deductibles) are associated with access to and use of SUD treatment and other health services in this complex patient population.”
From Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system (2020) · cites this paper as Saloner et al., 2017
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- Authors
- Saloner, B., Bandara, S., Bachhuber, M., & Barry, C. L.
- Affiliations
- Montefiore Medical Center (US)
- Venue
- Psychiatric Services
- Published
- 2017-06-01
- Volume
- 68
- Issue
- 6
- Pages
- 542-548
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2579882911
- Cited by
- 85
- References
- 19
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 7 · 2023: 2 · 2022: 11 · 2021: 8 · 2020: 9 · 2019: 15 · 2018: 10 · 2017: 9
- FWCI
- 21.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- Affordable Care Act, insurance coverage, mental illness, substance use disorders, mental health treatment utilization, addiction treatment, Medicaid, uninsured adults, low-income adults, health insurance expansion
- MeSH terms
- Adolescent, Adult, Mental Disorders, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Male, Medicaid, Middle Aged, Poverty, Regression Analysis, United States, Medically Uninsured, Insurance Coverage, Substance-Related Disorders, Young Adult, Patient Protection and Affordable Care Act
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