More people with schizophrenia have health insurance after Obamacare

The national unemployment rate for adults under age 65 with schizophrenia decreased by 50% after the Affordable Care Act (ACA) was enacted in 2014, according to research published this week at the University of Massachusetts Amherst. 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 research has shown that the overall national under-65 insurance rate decreased after the ACA went into 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 we were interested in seeing it because people with schizophrenia require ongoing care. It’s a very serious, chronic condition and it’s really important to have insurance, 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.”

Kimberley Geissler, 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, a lower rate than the general population, Geisler noted, because many people with schizophrenia may qualify for Medicaid and/or Medicare under disability provisions. .

Geisler and his team analyzed data from 2008 to 2020 from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS). The sample contained a total of 9.173 million individuals with schizophrenia, defined as having at least one medical encounter for a psychotic disorder over a two-year period. Researchers found a “significant decrease” in the percentage 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 saw a decrease in insurance mostly due to an increase in Medicaid coverage, which makes sense because Medicaid coverage generally grew faster with the ACA because of Medicaid expansion and the mandate for insurance that is no longer in effect,” Geisler says. Huh. “People who didn’t know they were eligible or who hadn’t previously applied for Medicaid were able to be covered after the ACA.”

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

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

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

According to University of Massachusetts Amherst research published this week in JAMA Psychiatry, the national uninsured rate for adults under age 65 with schizophrenia decreased by 50% after the implementation of 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 research has shown that the overall national under-65 insurance rate decreased after the ACA went into 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 we were interested in seeing it because people with schizophrenia require ongoing care,” said Kimberly Geisler, associate professor of health policy and management at UMass Amherst. it is said. School of Public Health and Health Sciences. “It’s a very serious, chronic condition and it’s really important to have insurance, but people with schizophrenia can have a lot of barriers to maintaining insurance. They’re less likely to be employed and because of their higher social status, among other things.” There are needs.”

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

Geisler and his team analyzed data from 2008 to 2020 from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS). The sample contained a total of 9.173 million individuals with schizophrenia, defined as having at least one medical encounter for a psychotic disorder over a two-year period. Researchers found a “significant decrease” in the percentage 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 saw a decrease in insurance mostly due to an increase in Medicaid coverage, which makes sense because Medicaid coverage generally grew faster with the ACA because of Medicaid expansion and the mandate for insurance that is no longer in effect,” Geisler says. Huh. “People who didn’t know they were eligible or who hadn’t previously applied for Medicaid were able to get covered after the ACA.”

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

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

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

source:

University of Massachusetts Amherst

Journal Reference:

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

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