After Obamacare, more adults with schizophrenia have health insurance

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The national uninsured rate for adults younger than 65 with schizophrenia fell by 50% after the Affordable Care Act (ACA) was implemented in 2014, according to University of Massachusetts Amherst research published this week in JAMA Psychiatry.

The Health Care Reform Act, also known as Obamacare, was designed to make health insurance affordable and available to all Americans. Previous research has shown that the overall rate for National Insurance under 65 years of age decreased after the ACA took effect, from 16.6% in 2010 to 11.0% in 2021.

“We didn’t know if we would see the same thing with people with schizophrenia and were interested in looking into this because people with schizophrenia need ongoing care,” says Kimberly Geissler, associate professor of health policy and management in the UMass Amherst School of Public Health and Health Sciences. “This is a very serious, chronic condition, and insurance is a really important thing, but people with schizophrenia can have a lot of barriers to maintaining insurance. They are less likely to be employed and have higher social needs, among other things.”

Before the Affordable Care Act, 8.4% of people with schizophrenia were uninsured, which is a lower rate than the general population, Gessler notes, because many people with schizophrenia may qualify for Medicaid and/or Medicare under disability provisions.

Gessler and her team analyzed data from 2008 to 2020 from the Agency for Healthcare Research and Quality’s (MEPS) Medical Expenditure Panel Survey. The sample totaled 9.173 million people with schizophrenia, who were defined as those who had at least one medical encounter with a mental disorder in a two-year period. The researchers found a “significant decrease” in the proportion of uninsured people with schizophrenia after the ACA. Before Obamacare, 8.4% were uninsured; After the ACA, the rate of uninsured people with schizophrenia dropped to 4%.

“We’ve seen this decrease in uninsuredness due to the increase in Medicaid coverage, which makes sense because Medicaid coverage has increased dramatically with the ACA due to the expansion of Medicaid and the insurance mandate that is no longer in effect,” says Geissler. “People who didn’t know they were eligible or had never applied for Medicaid before were able to get coverage after the ACA.”

About 70% of insured people with schizophrenia were covered by Medicaid post-ACA, compared to 61% before the ACA, the researchers calculated. Medicare coverage increased to 43% after the ACA from 38% before the ACA. Private insurance coverage decreased slightly to 19% after the ACA from 22% before the ACA.

Gessler says the findings are an encouraging step toward universal coverage for people with schizophrenia. “I was glad to see the uninsured rate was as low as it is. There are a lot of people who are covered now who weren’t covered before.”

The results also indicate that better care is available for this group of high-risk patients. “We know that having insurance improves a variety of outcomes, but we didn’t look specifically at whether this increased insurance rate for people with schizophrenia is associated with increased access,” she says. “We suspect it, but we don’t know for sure.”

more information:
Kimberley H. Geissler et al, Differences in insurance coverage for individuals with schizophrenia after implementation of the Patient Protection and Affordable Care Act, JAMA Psychiatry (2023). DOI: 10.1001/jamapsychiatry.2022.4628

Provided by the University of Massachusetts Amherst

the quote: Post-Obamacare, More Adults With Schizophrenia Have Health Insurance (2023, January 20) Retrieved January 21, 2023 from html

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