Monday, September 29, 2014

ACA Increased Access to Care for Young Dependents, Study Shows

Extended dependent coverage for young people under the Affordable Care Act appears to have produced modest increases in general hospital psychiatric inpatient admissions and higher rates of insurance coverage for young adults nationally.

And in California, the new coverage under the ACA appears to have lowered rates of emergency department visits, according to the report “Effect of the Affordable Care Act’s Young Adult Insurance Expansions on Hospital-Based Mental Health Care” in today's AJP in Advance.

The ACA requires insurers to permit children to remain on parental policies until age 26 as dependents. Researchers from multiple institutions sought to estimate the association between the dependent-coverage provision in the ACA and changes in young adults’ use of hospital-based services for substance use disorders and nonsubstance use psychiatric disorders.

They conducted a quasi-experimental comparison of a national sample of non-childbirth-related inpatient admissions to general hospitals and California emergency department visits with psychiatric diagnoses, using data spanning 2005 to 2011. Analyses compared young adults who were targeted by the ACA dependent-coverage provision (19- to 25-year-olds) and those who were not (26- to 29-year-olds), estimating changes in utilization before and after implementation of the dependent coverage provision.

They found that dependent coverage expansion was associated with 0.14 more inpatient admissions for psychiatric diagnoses per 1,000 for 19- to 25-year-olds (targeted by the ACA) than for 26- to 29-year-olds (not targeted by the ACA). The coverage expansion was associated with 0.45 fewer psychiatric emergency department visits per 1,000 in California. The probability that inpatient admissions nationally and emergency department visits in California were uninsured decreased significantly.

"It is gratifying when the putative benefits of a major policy change, such as the ACA, actually are realized in better access to services for individuals with behavioral health conditions,” said Howard Goldman, M.D., editor of Psychiatric Services and an expert on the ACA who is past chair of an APA work group on health reform. “In this instance, we hope that the observed increase in inpatient use and the decline in emergency visits reflect appropriate use of health care services. The inpatient increase surely reflects improved health insurance coverage--with benefits on par with those for general medical and surgical services."

More information on the Affordable Care Act appears in the Psychiatric News article "Lieberman Sees Promising Future for Psychiatrists, Patients" by Jeffrey Lieberman, M.D.

NOTE: Join your APA colleagues in responding to questions and comments from the public and patients in this week's #YourMH @TWITTER chat on Friday, October 3. The topic is bullying, in observance of National Bullying Prevention Month. To join, use #YourMH (stands for "Your Mental Health"), @APAPSYCHIATRIC, or #stopbullying. If you haven't created a Twitter account yet, click here to do so now. And during the chats, don't just sit on the sidelines—be a part of the conversation!


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