Abstract
We examine the impact of insurance expansion under the Affordable Care Act’s Dependent Care Expansion (DCE) on allocation of mental health care across illness severity, types of care and racial/ethnic groups. Evidence suggests that the increase in mental health care utilization resulting from the DCE was restricted to individuals with clinically significant mental health conditions. There is no evidence suggesting that the increase occurred disproportionately in medication-only treatment or that it increased racial/ethnic disparities. The DCE appears to have been successful in increasing utilization of mental health care among a high need group without lowering quality or increasing disparities.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, A. S., Soumerai, S. B., Zhang, F., Gilden, D., Burns, M., Huskamp, H. A., … Madden, J. M. (2015). Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression. Clinical Therapeutics, 37(3), 597–609. https://doi.org/10.1016/j.clinthera.2014.12.011.
Aldworth, J., Colpe, L. J., Gfroerer, J. C., Novak, S. P., Chromy, J. R., Barker, P. R., … Spagnola, K. (2010). The National Survey on Drug Use and Health Mental Health Surveillance Study: Calibration analysis. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 61–87. https://doi.org/10.1002/mpr.312.
Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., … Finkelstein, A. N. (2013). The Oregon experiment—Effects of medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713–1722. https://doi.org/10.1056/NEJMsa1212321. doi.
Breslau, J., Han, B., Stein, B. D., Burns, R. M., & Yu, H. (2017). Did the Affordable Care Act’s dependent coverage expansion affect race/ethnic disparities in health insurance coverage? Health Services Research. https://doi.org/10.1111/1475-6773.12728.
Breslau, J., Lane, M., Nancy, S. B., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research, 42(9), 708–716.
Breslau, J., Miller, E., Jin, R., Sampson, N. A., Alonso, J., Andrade, L. H., … Kessler, R. C. (2011). A multinational study of mental disorders, marriage, and divorce. Acta Psychiatrica Scandinavica, 124(6), 474–486. https://doi.org/10.1111/j.1600-0447.2011.01712.x.
Breslau, J., Stein, B. D., Han, B., Shelton, S., & Yu, H. (2018). Impact of the Affordable Care Act’s dependent coverage expansion on the health care and health status of young adults: What do we know so far? Medical Care Research and Review, 75, 131–152.
Center for Behavioral Health Statistics and Quality. (2016). 2014 National Survey on drug use and health: Methodological resource book (Sect. 10, Editing and Imputation Report). Rockville, MD Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUHmrbEditAndImp2014.pdf.
Collins, S. R., Robertson, R., Garber, T., & Doty, M. M. (2012). Young, uninsured, and in debt: Why young adults lack health insurance and how the Affordable Care Act is helping: Findings from the Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011. Issue Brief (Commonw Fund), 14, 1–24.
Colpe, L. J., Barker, P. R., Karg, R. S., Batts, K. R., Morton, K. B., Gfroerer, J. C., … Aldworth, J. (2010). The National survey on drug use and health mental health surveillance study: Calibration study design and field procedures. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 36–48. https://doi.org/10.1002/mpr.311.
Cook, B. L., Zuvekas, S. H., Carson, N., Wayne, G. F., Vesper, A., & McGuire, T. G. (2014). Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Services Research, 49(1), 206–229. https://doi.org/10.1111/1475-6773.12095.
DeLeire, T., Dague, L., Leininger, L., Voskuil, K., & Friedsam, D. (2013). Wisconsin experience indicates that expanding public insurance to low-income childless adults has health care impacts. Health Affairs, 32(6), 1037–1045. https://doi.org/10.1377/hlthaff.2012.1026.
Druss, B. G., Wang, P. S., Sampson, N. A., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2007). Understanding mental health treatment in persons without mental diagnoses: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 64(10), 1196–1203. https://doi.org/10.1001/archpsyc.64.10.1196.
Gibb, S. J., Fergusson, D. M., & Horwood, L. J. (2010). Burden of psychiatric disorder in young adulthood and life outcomes at age 30. The British Journal of Psychiatry, 197(2), 122–127. https://doi.org/10.1192/bjp.bp.109.076570.
Golberstein, E., Busch, S. H., Zaha, R., Greenfield, S. F., Beardslee, W. R., & Meara, E. (2015). Effect of the affordable care act’s young adult insurance expansions on hospital-based mental health care. American Journal of Psychiatry, 172(2), 182–189. https://doi.org/10.1176/appi.ajp.2014.14030375.
Han, B., Compton, W. M., Mojtabai, R., Colpe, L., & Hughes, A. (2016). Trends in receipt of mental health treatments among adults in the United States, 2008–2013. Journal of Clinical Psychiatry, 77(10), 1365–1371. https://doi.org/10.4088/JCP.15m09982.
Huhn, M., Tardy, M., Spineli, L. M., Kissling, W., Förstl, H., Pitschel-Walz, G., … & Leucht, S. (2014). Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: A systematic overview of meta-analyses. JAMA Psychiatry, 71(6), 706–715. https://doi.org/10.1001/jamapsychiatry.2014.112.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L. T., … Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. https://doi.org/10.1017/s0033291702006074.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., … Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184.
Kessler, R. C., & Ustun, T. B. (2004). The world mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121.
Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., … Kessler, R. C. (2011). Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine, 41(8), 1751–1761. https://doi.org/10.1017/S0033291710002291.
Novak, S. P., Colpe, L. J., Barker, P. R., & Gfroerer, J. C. (2010). Development of a brief mental health impairment scale using a nationally representative sample in the USA. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 49–60. https://doi.org/10.1002/mpr.313.
Park, M. J., Mulye, T. P., Adams, S. H., Brindis, C. D., & Irwin Jr, C. E. (2006). The health status of young adults in the United States. Journal of Adolescent Health, 39(3), 305–317. https://doi.org/10.1016/j.jadohealth.2006.04.017.
Saloner, B., & Le Cook, B. (2014). An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group. Health Affairs, 33(8), 1425–1434. https://doi.org/10.1377/hlthaff.2014.0214.
Shane, D. M., Ayyagari, P., & Wehby, G. (2016). Continued gains in health insurance but few signs of increased utilization: An update on the ACA’s dependent coverage mandate. Medical Care Research and Review, 73(4), 478–492. https://doi.org/10.1177/1077558715617066.
Slusky, D. J. (2015). Significant placebo results in difference-in-differences analysis: The case of the ACA’s parental mandate. Eastern Economic Journal, 43, 1–24.
Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The affordable care act has led to significant gains in health insurance and access to care for young adults. Health Affairs, 32(1), 165–174. https://doi.org/10.1377/hlthaff.2012.0552.
Sommers, B. D., & Kronick, R. (2012). The affordable care act and insurance coverage for young adults. JAMA, 307(9), 913–914. https://doi.org/10.1001/jama.307.9.913.
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 629–640.
Yu, J. W., Adams, S. H., Burns, J., Brindis, C. D., & Irwin, C. E. Jr. (2008). Use of mental health counseling as adolescents become young adults. Journal of Adolescent Health, 43(3), 268–276. https://doi.org/10.1016/j.jadohealth.2008.01.009.
Funding
This research was supported by a Grant from the National Institute on Minority Health and Health Disparities (R01 MD010274).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest to report.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study procedures were approved by the Human Subjects Protection Committee of the RAND Corporation.
Rights and permissions
About this article
Cite this article
Breslau, J., Stein, B.D., Yu, H. et al. Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care. Adm Policy Ment Health 46, 82–90 (2019). https://doi.org/10.1007/s10488-018-0895-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-018-0895-5