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Psychiatr Serv. 2018 Feb 1;69(2):231-234. doi: 10.1176/ Epub 2017 Nov 15.

Impact of ACA Health Reforms for People With Mental Health Conditions.

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Dr. Thomas is with Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. Dr. Shartzer is with the Urban Institute, Washington, D.C. Ms. Kurth and Dr. Hall are with the Institute for Health and Disability Policy Studies, Lawrence, Kansas. Dr. Hall is also with the Department of Health Policy and Management, University of Kansas Medical Center, Kansas City.



This brief report explores the impact of health reform for people with mental illness.


The Health Reform Monitoring Survey was used to examine health insurance, access to care, and employment for 1,550 people with mental health conditions pre- and postimplementation of the Affordable Care Act (ACA) and by state Medicaid expansion status. Multivariate logistic regressions with predictive margins were used.


Post-ACA reforms, people with mental health conditions were less likely to be uninsured (5% versus 13%; t=-6.89, df=50, p<.001) and to report unmet need due to cost of mental health care (17% versus 21%; t=-3.16, df=50, p=.002) and any health services (46% versus 51%; t=-3.71, df=50, p<.001), and they were more likely to report a usual source of care (82% versus 76%; t=3.11, df=50, p=.002). These effects were experienced in both Medicaid expansion and nonexpansion states.


Findings underscore the importance of ACA improvements in the quality of health insurance coverage.


Health care reform; Public policy issues


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