After the implementation of Obamacare, more people with schizophrenia have health insurance.

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In the year National insurance rates for adults under 65 dropped by 50% after the 2014 implementation of the Affordable Care Act (ACA), according to a Massachusetts Amherst study published this week. Jama Psychiatry.

Also known as Obamacare, the health care reform law was designed to make health insurance more affordable and accessible to all Americans. Previous studies have shown that the overall national under-65 uninsured rate has declined since the ACA went into effect, from 16.6 percent in 2010 to 11.0 percent in 2021.

We didn’t know if we’d see the same thing with people with schizophrenia, and we were interested in seeing this because people with schizophrenia need constant care. This is a serious, chronic illness and having insurance is very important, but people with schizophrenia can have many barriers to securing insurance. Among other things, they are less likely to remain employed and have higher social needs.


Kimberly Geisler, Associate Professor of Health Policy and Management, UMass Amherst School of Public Health and Health Sciences

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

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

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Medicaid coverage overall increased significantly with the ACA because of Medicaid expansion and the insurance mandate no longer in effect,” Geisler says.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

About 70 percent of insured people with schizophrenia are covered by Medicaid post-ACA, compared with 61% pre-ACA, the researchers calculated. Medicare coverage increased to 43 percent post-ACA, up from 38 percent pre-ACA. Private insurance coverage dropped slightly to 19% post-ACA from 22% pre-ACA.

Geisler said the findings are a step toward encouraging universal coverage for people with schizophrenia. “I was happy to see that the insurance rate is low. Many people are now covered who were not before.”

The findings also suggest better care for this vulnerable patient population. “We know that having insurance improves a range of outcomes, but we haven’t looked specifically at whether this increased insurance coverage among people with schizophrenia is related to access.” she says. “We suspect it is, but we don’t know for sure.”

According to a study published in JAMA Psychiatry by the University of Massachusetts Amherst, the national insurance rate for adults under 65 with schizophrenia dropped by 50% after the Affordable Care Act (ACA) in 2014.

Also known as Obamacare, the health care reform law was designed to make health insurance more affordable and accessible to all Americans. Previous studies have shown that overall declines in uninsured rates for those under 65 after the ACA went into effect, from 16.6 percent in 2010 to 11.0 percent in 2021.

“We didn’t know we’d see the same thing with people with schizophrenia, and we were interested in seeing this because people with schizophrenia need constant care,” said Kimberley Geisler, associate professor of health policy and management at UMass Amherst. School of Public Health and Health Sciences. “It’s a serious, chronic disease and having insurance is very important, but people with schizophrenia can have many barriers to maintaining insurance. They are less likely to remain employed and have greater social needs.”

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

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

“We’ve seen this decline in insurance largely due to an increase in Medicaid coverage, which makes sense because Medicaid coverage generally increased significantly with the ACA because of Medicaid expansion and the insurance mandate no longer in effect,” Geisler says. “People who didn’t know they were eligible or never applied for Medicaid before were able to get coverage after the ACA.”

About 70 percent of insured people with schizophrenia are covered by Medicaid post-ACA, compared with 61% pre-ACA, the researchers calculated. Medicare coverage increased to 43 percent post-ACA, up from 38 percent pre-ACA. Private insurance coverage dropped slightly to 19% post-ACA from 22% pre-ACA.

Geisler said the findings are a step toward encouraging universal coverage for people with schizophrenia. “I was happy to see that the insurance rate is low. Many people are now covered who were not before.”

The findings also suggest better care for this vulnerable patient population. “We know that having insurance improves a range of outcomes, but we haven’t looked specifically at whether this increased insurance coverage among people with schizophrenia is related to access.” she says. “We suspect it is, but we don’t know for sure.”

Source:

Journal Reference:

Geisler, KH, inter alia. (2023) Differences in insurance coverage after implementation of the Patient Protection and Affordable Care Act for individuals with schizophrenia. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2022.4628.

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