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What Medicaid Expansion Has Meant for Mental Health during COVID-19

Researchers reflect on the impact the Affordable Care Act has had on opening up access to mental health services.

As we enter our sixth month of social isolation, mental wellbeing has become a regular topic of conversation. And yet many lack access to support systems that could help. As many as 4.7 million Americans with mental health disorders are uninsured. Nearly 30% of people in need of mental health services report cost as a major deterrent.

Researchers Cameron Blazoski of Sidney Kimmel Medical College and Vittorio Maio, PharmD, from Jefferson College of Population Health recently wrote an article discussing the impact of the Affordable Care Act’s (ACA) Medicaid expansion. The two discuss how it gave many people access to essential mental health resources for the first time.

We spoke with the two about their work and its impact.

What led the two of you to look at this question and put together this paper?

Access to mental health care is a central issue that needs urgent attention and viable solutions. The Affordable Care Act and its Medicaid Expansion have tried to address this issue and have been fairly successful. This paper was written to summarize what we know and to urge policymakers to take appropriate action.

Why is it important to think about this now?  How has the COVID-19 pandemic impacted the need for mental health care?

The COVID-19 pandemic has increased rates of mental health disorders and substance abuse disorders, while at the same time, many Americans have lost their jobs and their health insurance. This combination of a growing incidence of mental health disorders and rising uninsured rates is likely to exacerbate the mental health crisis in America, and it emphasizes how further expansion can alleviate this burden.

Improvements in access to mental health care translated to improved mental health outcomes

What were some of the most convincing statistics you found in your research? 

When comparing states that expanded Medicaid to those that did not, expansion was linked to decreased uninsured rates, increased rates of physician visits, and increased mental health treatment among individuals with pre-existing mental health disorders. For example, one year after the ACA was implemented, the uninsured rate for low-income Americans with substance use disorders in expansion state dropped 14%, compared to a decrease of only 6.6% in non-expansion states. These improvements in access to mental health care translated to improved mental health outcomes, and these findings were consistent across the United States. In Michigan, new Medicaid enrollees were significantly more likely to report improvements in their mental health. Among southern states, expansion was linked to significantly less declines of mental health. Regardless where in the country expansion occurred, it improved mental health access and outcomes.

Why is access  to mental health services – via affordable health care — so important?

In 2017, less than half of Americans with a mental health disorder received mental health treatment, with 29.4% reporting not seeing a doctor specifically, due to cost. That same year, 4.7 million Americans with a mental health disorder were uninsured. There are clear, direct links between health insurance and improved mental health outcomes, and for many low-income Americans suffering from mental health disorders, Medicaid is their only viable option for health insurance.

What’s one thing you’d like readers to know?

Based on our findings and other research on the ACA, it is clear that opposition to Medicaid Expansion is rooted in politics, not science. This has directly impacted the health of America; in 2018, more than 2.3 million Americans met the criteria for Medicaid under the ACA but did not have insurance because they lived in a non-expansion state.

Most Americans do not recognize the mental health crisis in our nation.

The future of Medicaid Expansion is also increasingly unclear. With the passing of Justice Ruth Bader Ginsburg and an upcoming November Supreme Court ruling on the ACA, it is very possible that Medicaid expansion could be ruled unconstitutional.

At the same time, there is hope. This summer, the citizens of Oklahoma and Missouri (two historically conservative states) both voted to expand Medicaid. Today, only 12 states have not yet expanded their Medicaid programs. Medicaid expansion is an increasingly popular program among liberal and conservative Americans, and assuming it is ruled constitutional, we hope that further expansion is in the future.

Do you have any plans to continue this line of study? What are they?

We have recently discussed similar research topics, such as the impact a “Medicare for All” healthcare plan would have on mental health care. While the rates of mental health disorders continue to climb, most Americans do not recognize the mental health crisis in our nation. We hope that through our research, we are able to shed a light on the topic and discuss ways to address it.

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