Medicare and ACA enrollees were more likely to have trouble being accepted as a new patient during the previous 12 months than those with employer-sponsored insurance. (Photo: Shutterstock)
Looking for an appointment for mental health care? Check your coverage—if you have insurance through an Affordable Care Act marketplace-sponsored plan, you're less likely to get it than if you're requesting it through an employer-sponsored plan or Medicare.
So finds a study published in the May 2019 issue of Health Affairs, “Insurance-Based Disparities In Access, Utilization, And Financial Strain For Adults With Psychological Distress.”
According to the study, adults with mental health needs were more likely to actually get care, pay less out of pocket for it and have greater access to it if their coverage came from an employer or from Medicare than if they bought coverage through an ACA marketplace.
To arrive at this conclusion, researchers at Drexel University's Dornsife School of Public Health used data from the National Health Interview Survey on adults with mental illness to measure whether they had received care in the past 12 months and how affordable the treatment was.
People with coverage through an employer had the best rate of success, even though 5 percent of them still reported trouble getting an appointment with a mental health doctor over the past 12 months. They did well compared with both Medicare and ACA coverage, whose customers reported problems at the rates of 9 percent and 12 percent, respectively.
And that wasn't the only problem for Medicare and ACA folks, who also reported at rates of 9 percent and nearly 12 percent, respectively, said they weren't able to be accepted as a new patient during the previous 12 months.
Says the report, “Of the 44.7 million adults with a mental illness in the United States, only 43.1 percent received treatment in the previous year in 2016. The ACA mandates coverage of behavioral health services in Medicaid and all exchange health plans, and expands protections in individual and small-group insurance markets.”
“Although the ACA added about 20 million people to the number of insured in the United States, significant disparities remain,” says lead author Ryan McKenna, Ph.D., M.A., an assistant professor of health management and policy in Drexel University's Dornsife School of Public Health. ”Policy makers must look at this data and remedy these barriers for millions of Americans.”
The authors suggest not only adding a rating system like the Star Rating System for Medicare to grade the quality and size of a plan's network, but also simplifying administrative processes to bring more behavioral health specialists into the system to combat a shortage of practitioners.
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
