ACA Improved Access to Health Insurance for People with Schizophrenia

The Patient Protection and Affordable Care Act (ACA) helped boost health insurance coverage for individuals with schizophrenia, according to data published in JAMA Psychiatry.

Between 0.25 percent and 0.64 percent of people in the US have schizophrenia. The mental illness is associated with reduced life expectancy, comorbid diseases, and high healthcare costs. Health insurance coverage can help ensure this population has access to the healthcare required for treatment.

Provisions included in the ACA may have helped increase health insurance access for people with schizophrenia, such as expanding Medicaid, creating health insurance marketplaces, and establishing behavioral health services as an essential health benefit.

Researchers used data from the Medical Expenditure Panel Survey (MEPS) from 2008 to 2020 to determine how ACA implementation impacted insurance coverage for those with schizophrenia.

The pre-ACA period lasted from 2008 to 2013 and the post-ACA period was from 2014 to 2020. The study sample included 9.1 million people with schizophrenia.

The share of people who were uninsured decreased from 8.4 percent in the pre-ACA period to 4 percent in the post-ACA period, signifying a 4.5 percentage point reduction. The share of individuals with any Medicaid coverage increased by 8.7 percentage points, while the share with Medicare coverage rose by 5 percentage points.

The percentage of people with only Medicaid coverage and the share of those with both Medicaid and Medicare also increased after the ACA was passed.

The ACA and its accompanying provisions helped reduce uninsurance rates among people with schizophrenia, but ensuring access to health insurance for members with mental illness should continue to be a key priority for payers.

Data from the Kaiser Family Foundation (KFF) found that uninsured adults with moderate to severe symptoms of anxiety or depression were less likely to receive mental healthcare services compared to adults with healthcare coverage. In 2019, almost 22 million adults reported having these symptoms, but 8.5 million of these individuals did not receive treatment.

Over 60 percent of uninsured adults reported not receiving treatment, compared to 35 percent of Medicaid beneficiaries and 34 percent of Medicare beneficiaries. Around two in ten adults said they skipped or delayed therapy due to the cost.

A study published in JAMA Network Open found that receiving outpatient behavioral health treatment was associated with lower healthcare costs among patients with newly diagnosed behavioral health conditions. Those who did not receive treatment had higher per member per month costs.