Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 19, Issue 1, 2016. Pages: 3-20
Published Online: 1 March 2016

The Effects of the Affordable Care Act Adult Dependent Coverage Expansion on Mental Health

Marguerite E. Burns,¹* Barbara L. Wolfe²

¹Ph.D., University of Wisconsin - Madison, Department of Population Health Sciences, Madison, USA
²Ph.D., University of Wisconsin - Madison, Departments of Economics, Population Health Sciences and La Follette School of Public Affairs, Madison, WI, USA

* Correspondence to: Marguerite E. Burns, Ph.D., University of Wisconsin - Madison, Department of Population Health Sciences, Room 501 WARF Building, 610 N. Walnut St., Madison, WI 53726, USA.
Tel.: +1-608-265 5282
Fax: +1-608-263 2820
E-mail: meburns@wisc.edu

Source of Funding: We appreciate funding support from a NIMH Career Development Award (K01 092338).

Abstract

In September 2010, the ACA increased the availability of private health insurance for young adult dependents and prohibited coverage exclusions for their pre-existing conditions. The coverage expansion improved young adults’ financial protection from medical expenses and increased their mental health care use. These short-term effects signal the possibility of accompanying changes in mental health. We estimate the effect of the policy for young adults ages 23-25 on multiple measures of mental health relative to adults ages 27-29 using a difference-in-differences framework. We found that for young adults, there were few short-term changes in mental health relative to older adults. Rather, the overall pattern of findings suggests that both age groups experienced modest improvements in a range of outcomes. The notable exception to this pattern is a small but likely meaningful improvement in the SF-12 MCS score among young adults reflecting emotional well-being, mental health symptoms, and social role functioning.

Background: In September 2010, the Affordable Care Act increased the availability of private health insurance for young adult dependents in the United States and prohibited coverage exclusions for their pre-existing conditions. The coverage expansion improved young adults' financial protection from medical expenses and increased their mental health care use. These short-term effects signal the possibility of accompanying changes in mental health through one or more mechanisms: treatment-induced symptom relief or improved function; improved well-being and/or reduced anxiety as financial security increases; or declines in self-reported mental health if treatment results in the discovery of illnesses.

Aims: In this study, we estimate the effects of this insurance coverage expansion on young adults' mental health outcomes one year after its implementation.

Methods: We use a difference-in-differences (DD) framework to estimate the effects of the ACA young adult dependent coverage on mental health outcomes for adults ages 23-25 relative to adults ages 27-29 from 2007-2011. Outcome measures include a global measure of self-rated mental health, the SF-12 mental component summary (MCS), the PHQ-2 screen for depression, and the Kessler index for non-specific psychological distress.

Results: The overall pattern of findings suggests that both age groups experienced modest improvements in a range of outcomes that captured both positive and negative mental health following the 2010 implementation of the coverage expansion. The notable exception to this pattern is a 1.4 point relative increase in the SF-12 MCS score among young adults alone, a measure that captures emotional well-being, mental health symptoms (positive and negative), and social role functioning.

Discussion: This study provides the first estimates of a broad range of mental health outcomes that may be responsive to changes in mental health care use and/or the increased financial security that insurance confers. For the population as a whole, there were few short-term changes in young adults' mental health outcome relative to older adults. However, the relative increase in the SF-12 score among young adults, while small, is likely meaningful at a population level given the observed effect sizes for this measure obtained in clinical trials.

Implications: The vast majority of mental illnesses emerge before individuals reach age 24. Public policy designed to expand health insurance coverage to this population has the potential to influence mental health in a relatively short time frame.

Received 27 October 2015; accepted 30 December 2015