Lack of access to mental health care has been a problem among young adults in the U.S. In addition to the social stigma that surrounds mental health disorders, lack of insurance coverage and limitation to mental health care services are among the major reasons for this dilemma. However, the National Bureau of Economic Research (NBER) released a report in June which says the Affordable Care Act (ACA) improves the access to mental healthcare among young adults. As per the report, expanded coverage for young adults under this healthcare reform significantly increased inpatient hospital visits related to mental health. The healthcare law allows young adults under age 26 to stay on their parents’ group insurance plans started in late 2010.
NBER Study – Key Findings
- The overall number of inpatient visits related to mental health among young adults aged 19-25 years increased to 3.5 percent compared to people aged 27 to 29 who could not be staying on their parents’ plans.
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- After the implementation of ACA, mental health admissions of young adults increased by 9 percent.
- As a result of the Obamacare implementation, the number of young adults with private insurance in the treatment group involved in the survey increased by 2.1 and 6 percentage points.
- The number of young adults without health insurance in the treatment group involved in the survey decreased by a marginally statistically significant 1 percent and statistically significant 2.9 percentage since the enactment and implementation of the healthcare reform.
- The national study revealed that a major portion of psychiatric admissions came through the emergency department.
- While dividing mental health category into subcategories of depression, psychoses and other mental illnesses using the relevant ICD 9 codes during the study, large and statistically significant increases were found in all inpatient admissions and visits through the emergency room (ER) for depression post Obamacare. The study observed a sizable increase in psychoses admissions as well.
The results from the study are slightly confusing as the experts say when Massachusetts expanded medical coverage with its 2006 state-based health reform law, no significant increases were found in the number of mental-health hospitalizations for young adults there. In the opinion of healthcare experts, community caregivers may have largely met the needs of newly insured people saving them from visiting ERs for critical care.
Three Ways in which ACA Enhances Mental Health Care Access
- ACA builds on the Mental Health Parity and Addictions Equity Act in order to expand mental health and substance use disorder benefits and federal parity protections for more than 60 million people in the U.S., which is one of the biggest expansions in behavioral health coverage.
- Under the healthcare law, insurance companies can no longer deny healthcare coverage or charge more because of a pre-existing health condition including mental illness.
- Most healthcare plans must cover preventive services including depression screening for adults at no cost as per this law.
Challenges for Hospitals with Improved Access
Rise in inpatient psychiatric services is surely a positive sign to hospitals as they will get more reimbursement. However, this trend poses several challenges to healthcare organizations as well, such as:
- Managing Surge with Limited Resources – As the number of inpatient visits increases, hospitals will have to manage their healthcare needs with the resources they already have. A 2012 Treatment Advocacy Center report reveals a significant shortage in the number of psychiatric beds nationwide from 2005-2010. The healthcare reform will also impel the use of advanced patient care technologies. In such a scenario, hospital executives will require to accomplish a huge task of managing a delivery system in which more patients will be chasing fewer resources.
- Increased Public Scrutiny – As several patients get insured newly with the health care reform, they will seek help from litigators and activists to understand more about the coverage. They will handle patients’ complaints against the level of care and as a result hospitals can expect an increase in lawsuits and public exposure.
- Financial Burden – Young adults who don’t want to stay under parents’ coverage may qualify for Medicaid under provisions of Obamacare which expand health care coverage to individuals who earns up to 138 percent of the federal poverty level, depending on their income and the location where they dwell. But, hospitals face a reduction of $14.1 billion from FY 2014 through 2019 in Medicaid Disproportionate Share Payment (DSH) under Obamacare. Young adults staying under parents’ coverage may sometimes qualify for tax subsidies depending on their income. This will require hospitals to verify insurance documents thoroughly before the actual visit.
- Shortage of Psychiatrists – A recent report suggests that psychiatrists are in short supply nationwide. Thus, the hospital executives should not only manage the surge of inpatient visits with limited resources, but with fewer practicing psychiatrists as well.
Hospitals will require the help of professionals to manage the revenue cycle amidst these challenges and receive proper reimbursement without any delay.
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